Effectiveness of nurse-led self-care interventions on self-care behaviours, self-efficacy, depression, and illness perceptions in people with heart failure: a meta-analysis
Authors: Huang Z , Liu T , Chair S 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Insufficient self-care behaviours, low self-efficacy, depression, and poor illness perceptions are obstacles to the management of people with heart failure, leading to adverse patient outcomes. Self-care interventions are strategies used to support individuals in self-care. Currently, evidence on the effects of nurse-led self-care interventions on self-care behaviours and the correlates (self-efficacy, depression, and illness perceptions) in people with heart failure is scarce.

Objectives
This meta-analysis aims to systematically synthesize current evidence to determine the effectiveness of nurse-led self-care interventions on self-care behaviours, self-efficacy, depression, and illness perceptions among people with heart failure and identify the characteristics of effective nurse-led heart failure self-care programs.

Methods
MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and PsycINFO were electrically searched for relevant articles from the inception to December 2021. Randomised controlled trials examining the effects of nurse-led self-care interventions on self-care behaviours, self-efficacy, depression, and illness perceptions among people with heart failure published in the English language were included. The quality appraisal of included studies was performed using the revised Cochrane tool for assessment of the risk of bias in randomised controlled trials (RoB 2.0). The meta-analysis was conducted using Review Manager 5.4 and Stata SE 16.0. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results
Twenty-four studies with 2488 participants were identified in this review. The results of our study revealed that nurse-led self-care interventions significantly improved self-care maintenance (MD: 9.93, 95% CI: 5.24 to 14.61, P&lt;0.001, low certainty of evidence), self-care management (MD: 13.54, 95% CI: 6.84 to 20.23, P&lt;0.001, moderate certainty of evidence), self-efficacy (SMD: 0.90, 95% CI: 0.58 to 1.22, P&lt;0.001, low certainty of evidence), depression (SMD: -0.51, 95% CI: -0.66 to -0.35, P&lt;0.001, high certainty of evidence), and illness perceptions (SMD: 1.99, 95% CI: 1.57 to 2.42, P&lt;0.001, moderate certainty of evidence) among people with heart failure. Moreover, subgroup analyses indicated that the ideal duration of intervention for enhancing self-care behaviours, self-efficacy, and reducing depression in people with heart failure was 1 to 3 months.

Conclusions
This review provides low to high certainties of evidence supporting the beneficial effects of the nurse-led self-care interventions on self-care behaviours, self-efficacy, depression, and illness perceptions among people with heart failure. The duration of the intervention is one of the factors that may affect the intervention effects. Further well-designed randomised controlled trials are recommended to strengthen the current evidence.