The Development of Cultural-Specific Caregiver Telephone Coaching Program to Improve Heart Failure (HF) Home Care

Friday, 25 July 2014

Ubolrat Piamjariyakul, PhD, RN
School of Nursing, University of Kansas Medical Center, Kansas City, KS
Carol E. Smith, PhD, FAAN, RN
School of Nursing, University of Kansas, Kansas City, KS

Background: The significance of this study is related to the prevalence of HF in African Americans at younger ages, with earlier severe complications and mortality. In addition, the economic burden of HF affects these populations greatly. Ethnic-specific needs must be identified to help patients and family caregivers. Thus, a program to provide African American caregivers with skills to improve HF home care, reduce patient rehospitalization costs, and prevent caregiver burden is critically needed.

Purpose: Qualitative data from patients, family caregivers, and professionals experienced in HF care and national clinical guidelines were used to guide the development of cultural-specific caregiver telephone coaching program (FamHFcare). Coaching and teach-back strategies were used throughout.

Methods: The University Medical Center Institutional Review Board approved the study.  FamHFcare program was developed from qualitative data, feasibility study, and using national clinical guidelines HF home care management contents as a guide. The project was completed in two interrelated phases: (1) conducted qualitative community based participatory study (n=30) to identify cultural-specific preferences of African American families managing HF at home; and (2) current African American feasibility study funded by Blue Cross Blue Shield (n=10 caregivers).

Results: The program was nurse-led and conducted in 5 telephone coaching sessions.  Each coaching session includes information about HF management related to specific cultural strengths and challenges. Since African Americans have multiple family caregivers who want to help (but may not know how to), the nurse coach helps the family coordinate arrangement for transportation, chores, and support telephone contacts and easy-to-follow daily home care routines. The materials on dietary sodium management have been modified for cultural preferences in common African American diets. Applications for reduced-cost drug programs are completed.  Coaching is given on comorbid symptom recognition, and dietary and physical activity instructions per physicians and national core HF measures guides. Visuals for assessing cyanosis and edema in darker skinned individuals are used. The nurse helps patients and caregivers practice monitoring and timely reporting of HF symptoms to professionals. As a reinforcement for cementing the FamFHcare information each caregiver is asked to "teach back" to the nurse what was learned in each session. The results from the current comparison study (n=10) indicates that there was a 24.5% improvement in the caregivers’ HF knowledge, symptom monitoring and reporting in week two following the coaching session. Further, following the second session there was only one caregiver requiring educational reinforcement in week two. 

Conclusion: This project described critical steps in developing cultural-specific caregiver telephone coaching program. The coaching program was evaluated as helpful in problem-solving HF related home care challenges.