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Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.

ABSTRACT: OBJECTIVE:To examine the perspectives of adults with heart failure (HF) about numerical concepts integral to HF self-care. SETTING:This qualitative study took place at an urban academic primary care practice. PARTICIPANTS:Thirty men and women aged 47-89?years with a history of HF were recruited to participate. Eligibility criteria included: a history of HF (?1?year), seen at the clinic within the last year, and a HF hospitalisation within the last 6?months. Non-English speakers and those with severe cognitive impairment were excluded. METHODS:In-depth semistructured interviews were conducted. Participants were interviewed about numeracy across three domains of HF self-care: (1) monitoring weight,(2) maintaining a diet low in salt and (3) monitoring blood pressure. Interviews were audio-taped, transcribed verbatim and analysed using grounded theory and word cloud techniques. RESULTS:Five key themes reflecting participants' attitudes towards numerical concepts pertaining to weight, diet and blood pressure were identified: (1) Communication between healthcare providers and patients is a complex, multistage process; (2) Patients possess a wide range of knowledge and understanding; (3) Social and caregiver support is critical for the application of numerical concepts; (4) Prior health experiences shape outlook towards numerical concepts and instructions and (5) Fear serves as a barrier and a facilitator to carrying out HF self-care tasks that involve numbers. The findings informed a theoretical framework of health numeracy in HF. CONCLUSION:Effective communication of numerical concepts which pertain to HF self-care is highly variable. Many patients with HF lack basic understanding and numeracy skills required for adequate self-care. As such, patients rely on caregivers who may lack HF training. HF-specific training of caregivers and research that seeks to elucidate the intricacies of the patient-caregiver relationship in the context of health numeracy and HF self-care are warranted.

SUBMITTER: Sterling MR

PROVIDER: S-EPMC6150136 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.

Sterling Madeline R MR Silva Ariel F AF Robbins Laura L Dargar Savira K SK Schapira Marilyn M MM Safford Monika M MM

BMJ open 20180919 9

<h4>Objective</h4>To examine the perspectives of adults with heart failure (HF) about numerical concepts integral to HF self-care.<h4>Setting</h4>This qualitative study took place at an urban academic primary care practice.<h4>Participants</h4>Thirty men and women aged 47-89 years with a history of HF were recruited to participate. Eligibility criteria included: a history of HF (≥1 year), seen at the clinic within the last year, and a HF hospitalisation within the last 6 months. Non-English spea ...[more]

PMID: 30232115

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Project description:BackgroundHeart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient's experience may reframe the readmission "problem" and, ultimately, inform alternative strategies.ObjectiveTo understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission.DesignObservational qualitative study.ParticipantsHeart failure patients were recruited from two hospitals and included those who were hospitalized for heart failure at least twice within 30 days and those who had been recently discharged after their first heart failure admission.ApproachOpen-ended, semi-structured interviews. Conclusions vetted using focus groups.Key resultsSemi-structured interviews with 31 patients revealed a combination of physical and socio-emotional influences on patients' home heart failure management. Major themes identified were home management as a struggle between adherence and adaptation, and hospital readmission as a rational choice in response to distressing symptoms. Patients identified uncertainty regarding recommendations, caused by unclear instructions and temporal incongruence between behavior and symptom onset. This uncertainty impaired their competence in making routine management decisions, resulting in a cycle of limit testing and decreasing adherence. Patients reported experiencing hopelessness and frustration in response to perceiving a deteriorating functional status. This led some to a cycle of despair characterized by worsening adherence and negative emotions. As these cycles progressed and distressing symptoms worsened, patients viewed the hospital as the safest place for recovery and not a "negative" outcome.ConclusionCycles of limit testing and despair represent important patient-centered struggles in managing heart failure. The resulting distress and fear make readmission a rational choice for patients rather than a negative outcome. Interventions (e.g., palliative care) that focus on methods to address these patient-centered factors should be further studied rather than methods to reduce hospital readmissions.

Dataset Information

Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.

Publications

Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.

Similar Datasets

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