Depression is very common in patients with heart failure (HF). However, little is known about how depression influences self-care (ie, adherence to diet, medication and symptom management behaviors) in ethnic minority patients with HF. The purpose of this study was to explore the meaning of depression and how depressive symptoms affect self-care in an ethnic minority Black population with HF.
In this mixed methods study, 30 Black patients (mean age 59.63 SD +/- 15 years; 60% male) participated in in-depth interviews about HF self-care and mood; and completed standardized instruments measuring self-care, depression, and physical functioning. Thematic content analysis was used to explore the meaning of depression and elicit themes about how depressive symptoms affect daily self-care practices. Qualitative and quantitative data were integrated in the final analytic phase.
Self-care was very poor in the sample. Forty percent of the sample had evidence of depressive symptoms (PHQ-9 > or = 10; mean 7.59 +/- 5.29, range 0 to 22). Individuals with depressive symptoms had poorer self-care (P = .029). In the qualitative data, individuals described depressive mood as "feeling blue... like I failed." "Overwhelming" sadness and fatigue influenced self-care and resulted in treatment delays. For many, spirituality was central to coping with sadness. Few discussed depressive feelings with health care providers.
Depression in ethnic minority patients with HF may be difficult to assess. Research to develop and test culturally sensitive interventions is critically needed, since depression influences self-care and minority populations continue to experience poorer outcomes.
"Social support might result in improved self-care confidence, and subsequently improved self-care . Moreover, social networking might prove beneficial, specifically in the sub-population of Blacks with heart failure, because social support plays a crucial role in the successful management of heart failure in Blacks . Social networking might provide this crucial social support that is necessary for effective heart failure self-management in Blacks because evidence suggests that the source of social support is less important than the actual presence of a confidant with whom to discuss the impact of living with heart failure [18, 22, 47–49]; sharing this experience with others with heart failure who can identify may prove to be more efficacious for heart failure patients when compared to confiding in someone who is not living with the illness [38••]. "
[Show abstract][Hide abstract] ABSTRACT: Heart failure is a debilitating illness that requires patients to be actively engaged in self-management. Self-management practices, including maintenance and management of an evidence-based medication regimen, are associated with improved outcomes. Yet, sustained engagement with self-management practices remains a challenge. Both self-management practices and clinical outcomes differ by race, with the poorest self-management and clinical outcomes reported in Blacks. Contemporary interventions to address self-management and reverse current trends in outcomes have evaluated the use of technology. Technological innovations, such as text messaging, social networking, and online learning platforms may provide a more accessible means for self-management of heart failure, yet these innovations have been understudied in the population at greatest risk - Blacks with heart failure. We conducted a review and discovered only four studies evaluating use of technology for self-management in Blacks. More studies are needed to close the gap on racial disparities and use of technology for self-management.
Current Heart Failure Reports 07/2014; 11(3). DOI:10.1007/s11897-014-0213-9
[Show abstract][Hide abstract] ABSTRACT: The Northern Territory of Australia is a vast area serviced by two major tertiary hospitals. It has both a unique demography and geography, which pose challenges for delivering optimal heart failure services. The prevalence of congestive heart failure continues to increase, imposing a significant burden on health infrastructure and health care costs. Specific patient groups suffer disproportionately from increased disease severity or service related issues often represented as a The syndrome itself is characterised by ongoing symptoms interspersed with acute decompensation requiring lifelong therapy and is rarely reversible. For the individual client the overwhelming attention to heart failure care and the impact of health care gaps can be devastating. This gap may also contribute to widening socio-economic differentials for families and communities as they seek to take on some of the care responsibilities. This review explores the challenges of heart failure best practice in the Northern Territory and the opportunities to improve on service delivery. The discussions highlighted could have implications for health service delivery throughout regional centres in Australia and health systems in other countries.
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