Trajectory of self-care in people with stable heart failure and insomnia after two self-care interventions.
Samantha Conley, Sangchoon Jeon, Laura K Andrews and 5 others
PMID 36088189WHAT IT FOUND
The insomnia CBT and heart-failure self-care education groups did not differ in how self-care changed over 12 months.
Most participants still had inadequate self-care.
Key findings
01The insomnia CBT and heart-failure self-care education groups did not differ in how self-care changed over time.
02Four self-care trajectory classes were identified: low (26.8%), moderate (38.9%), adequate (24.0%), and optimal (10.3%).
03People in low and moderate self-care trajectories had more severe fatigue and anxiety, higher perceived stress, and lower cognitive abilities at baseline than those in adequate and optimal trajectories.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The self-care analyses were added after the trial was planned. The parent study was designed to detect effects on insomnia severity and fatigue, not self-care trajectories. They could not calculate the needed sample size for each trajectory class before the analysis because they did not know how many classes there would be. The findings may not apply to people with less stable heart failure or without insomnia. The self-care scale mainly measured adherence to prescribed therapies and did not capture sleep or stress-management self-care behaviors. The three self-care subscales showed only modest reliability in this sample (0.61 to 0.62). Multi-level factors such as health literacy, family support, community support, and ability to concentrate were not analyzed.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not conclude that CBT-I improves heart failure self-care more than heart failure self-care education. The two groups did not differ in how self-care changed over time, and most participants still had inadequate self-care.