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BACKGROUND: Worldwide, approximately 64 million people live with signs and symptoms of heart failure(HF), considered one of the leading causes of morbidity and mortality, hospitalizations and worsening of quality of life. Self-care is a nonpharmacological approach to control the progression of HF, which involves behaviors to maintain health and monitor and manage symptoms. However, self-care still insufficient among this population in Brazil and worldwide. The Educational Program for Self-Care in Heart Failure (PEAC-CI) is an acceptable and feasible intervention that needs to be evaluated for its effectiveness. OBJECTIVE: To evaluate the effectiveness of the PEAC-IC in improving self-care behaviors (primary outcome), knowledge, quality of life, the number of hospitalizations, and access to emergency services in patients with HF (secondary outcome). METHODS: A parallel randomized clinical trial with HF patients recruited in a clinical cardiology ward and outpatient settings of the Dante Pazzanese Institute of Cardiology in São Paulo/Brazil. Participants were randomized to the intervention group (IG), receiving the PEAC-CI intervention, and the control group (CG), receiving standard care. The intervention consisted of a face-to-face session followed by five structured telephone contacts every week during six weeks. Standard care consisted of general guidance during hospital discharge and outpatient follow-ups with medical and nursing consultations when indicated. The outcomes were assessed in seventh week or after the six sessions of the implementation of PEAC-IC, and then third and sixth month after the first assessment in both groups. The primary outcome was measured with the Self-Care of HF Index v.6.2, which measures selfcare maintenance, management, and confidence; scores of these three scales range between 0-100, with higher scores meaning better self-care. RESULTS: We enrolled 80 patients, and 56 completed the entire intervention. These patients were mostly males (52.5%), with a mean age of 61.8 years (SD= 12,6) 44.9% white, with a diagnosis of HF from an average of 174.9 (SD=158,3), 50% in New York Heart Association functional class III. At baseline, self-care maintenance, management, and confidence scores were 51.6, 56.2, and 54.1, respectively. At the seven-week follow-up, the IG scored 72.3 on self-care maintenance, while the CG scored 61. The difference between the two groups, assessed with the linear mixed model, was clinically and statistically significant (p0.05). CONCLUSION: The PEAC-CI has effectively improved self-care maintenance in patients with HF. Even though the improvement in the secondary outcomes was not statistically significant, we observed a trend towards statistically significance. Key-words: nursing; heart failure; self-care; randomized controled trial.

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AIM: The Self-Care Self-Efficacy Scale (SCSES) was newly developed as a self-report measure for self-care self-efficacy for chronic illness. This study investigated its measurement equivalence (ME) in different cultural groups, including United States, China (Hong Kong), Italy, and Brazil. DESIGN: A multi-national study for cross-cultural validation of the Scale. METHODS: From January 2015 - December 2018, investigators recruited 957 patients (United State: 200; Hong Kong: 300; Italy: 285; and Brazil: 142) with chronic illness from inpatient and outpatient settings. The SCSES was administered and clinical and demographic data were collected from participants. Based on the Meredith framework, multi-group confirmatory factor analysis evaluated the configural, metric, scalar, and strict invariance of the scale across the four populations through a series of nested models, with evaluation of reliability and coherence of the factor solution. RESULTS: The mean ages of the groups ranged from 65-77 years, 56.4% was male. The Cronbach's alpha coefficients of the single-factor SCSES were 0.93, 0.89, 0.92, and 0.90 for the United States, China (Hong Kong), Italy, and Brazil, respectively. Three of the four levels of ME were partially or totally supported. The highest level achieved was partial scalar invariance level (χ2 [52] = 313.4, p < 0.001; RMSEA = 0.067; 95% CI = 0.056-0.077; CFI = 0.966; TLI = 0.960, SRMR = 0.080). CONCLUSION: Patients from the four countries shared the same philosophical orientation towards scale items, although some of the items contributed differently to represent the concept and participants shared the same schemata for score interpretation. IMPACT: Self-efficacy is important in producing effective and sustainable self-care behavioural changes. Cultural ideation shapes the ways individuals interpret and report their self-care self-efficacy. The study findings support cross-cultural and cross-national utility of the SCSES for research on self-care across United States, China (Hong Kong), Italy, and Brazil.

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BACKGROUND: Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics. OBJECTIVE: The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil. METHODS: A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability. RESULTS: The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95-1.00; root-mean-square error of approximation, 0.00-0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77-0.96). CONCLUSIONS: The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.

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BACKGROUND: Poor self-care in patients with hypertension is associated with worse patient outcomes. The Self-Care of Hypertension Inventory (SC-HI) measures self-care in patients with hypertension and includes three scales: self-care maintenance, which measures adherence to prescribed treatments and behaviors; self-care management, which evaluates the responses to signs and symptoms of high blood pressure; and self-care confidence, which measures self-efficacy in dealing with the entire process. OBJECTIVE: To test the psychometric characteristics of the Brazilian version of the SC-HI. METHODS: We enrolled a sample of 360 patients with hypertension and performed confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to test the factorial structure of the SC-HI and computed the factor score determinacy coefficient to evaluate the SC-HI internal consistency reliability. RESULTS: The sample was predominantly female (65%), mean age of 65 years (SD = 10), white (70%). The self-care maintenance scale resulted in a unidimensional scale, with supportive fit indices (CFI = 0.901, RMSEA = 0.048); the self-care management did not reflect the original factorial structure and had unsupportive fit indices. EFA showed a different factorial solution in reference to the original study. Finally, the self-care confidence scale resulted in a unidimensional scale with supportive fit indices (CFI = 0.940, RMSEA = 0.093). The reliability of the self-care maintenance, management, and confidence scales resulted in factor score determinacy coefficients of 0.83, 0.78, and 0.97 respectively. CONCLUSION: This study shows that the SC-HI is a valid and reliable tool to measure self-care in patients with hypertension among the Brazilian population.

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OBJECTIVE: Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS: Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS: In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION: Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS: Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.

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