New Approach Assesses Barrier To Self Care In Heart Failure Patients

Richard J. Holden, PhD Assistant Professor Department of BioHealth Informatics Indiana University School of Informatics and Computing – Indianapolis Indianapolis, IN Interview with:
Richard J. Holden, PhD Assistant Professor
Department of BioHealth Informatics
Indiana University
School of Informatics and Computing – Indianapolis
Indianapolis, IN  46202

Medical Research: What was your motivation for this study?

Dr. Holden: Many patients arrive in the emergency room with acute heart failure (AHF), a worsening of their chronic heart failure condition. These visits and subsequent hospital admissions and readmissions for acute heart failure represent a sizeable cost in the US healthcare system. Evidence suggests that some of these cases could be prevented if patients were better able to perform self-care activities such as monitoring their symptoms, taking medications, getting exercise, and maintaining a sodium-restricted diet. However, in community-based studies that we and others have done, patients with heart failure face a variety of barriers to optimally performing self-care. We therefore created an instrument to assess barriers to self-care, which we designed to be implemented in the emergency room. We tested the instrument with 31 patients with acute heart failure at Vanderbilt University’s adult Emergency Department.

Medical Research: What are the main findings?

Dr. Holden: Almost everyone who participated reported experiencing barriers to self-care. A median of 15 barriers per patient were reported. Of the 47 barriers that we tested, 34 were reported by at least one quarter of participants. The top ten most prevalent barriers included individual-level factors such as physical disability, disease knowledge, and memory deficits as well as factors related to the organization of home life, including major disruptions such as holidays. Other barriers were related to inadequate health information, low literacy, and lack of resources. Many barriers interacted with one another, for example, lack of transportation yet not wanting to rely on others. We found that the instrument could be feasibly administered within a short period following the patient’s emergency room arrival.

Medical Research: Were you surprised by any of the findings?

Dr. Holden: Because the instrument was designed to prompt patients to provide additional information, we learned not only that they had barriers, but the specific nature of those barriers. We spoke to one patient who described difficulty balancing his self-care and health behavior with other responsibilities, including a full-time job. Another patient, described in the paper, explained to researchers her concerns about obtaining access to affordable care and keeping her job. These narratives showed the complexity of self-care in the context of people’s lives and the potential challenges to adherence to self-care recommendations.

Medical Research: What should clinicians and patients take away from your report?

Dr. Holden: Clinicians should be aware that these self-care barriers exist and may be quite prevalent. It is possible that clinicians are aware of some if not all of their patients’ barriers. However, in the emergency room, it can be difficult for clinicians to thoroughly assess patients’ barriers during a short, unstructured interaction. Our instrument can be used for rapid, comprehensive assessment of self-care barriers in the emergency room and other settings or for research on patients’ barriers to self-care. Patients should be aware of the self-care challenges that they may encounter and that these may profoundly affect their ability to perform self-care.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Holden: The instrument that we developed can be further refined and tested in other settings, including emergency rooms with a different case mix or in different geographic locations. Cross-cultural comparisons are also encouraged; we have been collecting data in parallel at a hospital in Singapore and the differences in the two samples are intriguing. A key next step is to embed the instrument into routine healthcare delivery to test the value of measuring and addressing barriers to self-care as part of standard clinical practice.


Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach

Richard J. Holden, PhD, , Christiane C. Schubert, PhD Eugene C. Eiland, MD,

Alan B. Storrow, MD, Karen F. Miller, RN, MPA, Sean P. Collins, MD, MSc

Annals of Emergency Medicine Available online 19 January 2015

[wysija_form id=”1″] Interview with:, & Richard J. Holden, PhD Assistant Professor (2015). New Approach Assesses Barrier To Self Care In Heart Failure Patients