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Author Notes:

Corresponding author: Sandra B. Dunbar, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, GA 30322, sbdunba@emory.edu


Research Funding:

Funded in part by the National Institutes of Health National Institute of Nursing Research grant number R21NRO11204 (PI-S. Dunbar) and by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454 (PI-D. Stephens), and the Atlanta Veterans Administration Medical Center.

Also effort was funded for B. Butts through the National Institutes of Health National Institute of Nursing Research grant number T32NR012715 (PI-S. Dunbar).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Nursing
  • Heart failure
  • Diabetes
  • Intervention
  • Self-care

A pilot test of an integrated self-care intervention for persons with heart failure and concomitant diabetes


Journal Title:

Nursing Outlook


Volume 62, Number 2


, Pages 97-111

Type of Work:

Article | Post-print: After Peer Review


Studies show 30% to 47% of people with heart failure (HF) have concomitant diabetes mellitus (DM). Self -care for persons with both of these chronic conditions is conflicting, complex, and often inadequate. This pilot study tested an integrated self-care program for its effects on HF and DM knowledge, self-care efficacy, self-care behaviors, and quality of life (QOL). Hospitalized HF-DM participants (N = 71) were randomized to usual care or intervention using a 1:2 allocation and followed at 30 and 90days after intervention. Intervention was an integrated education and counseling program focused on HF-DM self-care. Variables included demographic and clinical data, knowledge about HF and DM, HF- and DM-specific self-efficacy, standard HF and DM QOL scales, and HF and DM self-care behaviors. Analysis included descriptive statistics, multilevel longitudinal models for group and time effects, post hoc testing, and effect size calculations. Sidak adjustments were used to control for type 1 error inflation. The integrated HF-DM self-care intervention conferred effects on improved HF knowledge (30days, p = .05), HF self-care maintenance (30 and 90days, p < .001), HF self-care management (90days, p = .05), DM self-efficacy (30days, p = .03; 90days, p = .004), general diet (30days, p = .05), HF physical QOL (p = .04), and emotional QOL scores (p = .05) at 90days within the intervention group. The participants in the usual care group also reported increased total and physical QOL. Greater percentages of participants in the intervention group improved self reported exercise between 0 and 30days (p = .005 and moderate effect size ES = .47) and foot care between 0 and 90days (p = .03, small ES = .36). No group differences or improvements in DM-specific QOL were observed. An integrated HF-DM self-care intervention was effective in improving essential components of self-care and had sustained (90day) effects on selected self-care behaviors. Future studies testing HF-DM integrated self-care interventions in larger samples with longer follow-up and on other outcomes such as hospitalization and clinical markers are warranted.

Copyright information:

© 2014 Elsevier Inc.

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