Abstract 14900: The Effect of a “Teach to Goal” Telephone Education and Counseling vs. Brief Educational Intervention on Self-Care Behaviors and Heart Failure Symptoms in Low Literacy Latinos
Background: Heart failure (HF) is common and has substantial morbidity and mortality, particularly in Spanish-speaking Latinos. Latinos may have difficulty performing self-care (SC) behaviors because of literacy, language, and cultural influences. We conducted a randomized trial to determine whether a “teach to goal” (TTG) educational and behavioral support program was more successful than a brief educational intervention (BEI) for promoting SC behaviors and improving HF symptoms in Latinos.
Methods: We recruited patients from 4 academic medical centers who had symptomatic HF (NYHA class II-IV). All received a one hour educational session with a focused curriculum for promoting self-care behaviors. Patients were then randomized to no further intervention or the TTG program, which immediately taught adjusted-dose diuretics to maintain a target weight and reinforced learning goals and behaviors with 5-8 telephone counseling sessions over the next month. A telephone interview was conducted to assess SC behaviors and HF Symptom Scale (HFSS; range 0-100, with higher scores denoting fewer symptoms) at baseline and one month. Literacy was measured by the short Test of Functional Health Literacy in Adults (TOHFLA).
Results: A sample of 97 Latino participants with mean age of 61 years; 49% male; 73% had less than a high school education; 68% had ejection fraction < 0.45; 42% were NYHA class III or IV; mean TOFHLA score of 14+/−12, completed the one month telephone interview. Patients in the TTG group reported substantially greater increases in the composite index of 10 SC items than the BEI group (increase from mean of 3.6 to 7.3 for TTG vs. increase 4.1 to 5.9 for BEI; p<0.001), including awareness of their ideal weight, checking weight daily, self-adjusting diuretic dose to maintain target weight, and having an action plan for a weight gain of ≥ 4 lbs. The HFSS improved from 51 to 65 for the TTG group and 57 to 64 for the BEI group (p = 0.02 for the difference in change scores).
Conclusions: The TTG strategy of a telephone education and counseling program was successful in improving self care behaviors and HF symptoms in low literacy Latinos. Longer follow-up is needed to determine whether these differences are sustained and whether the TTG strategy decreased hospitalizations.
- © 2011 by American Heart Association, Inc.