Volume 28, Issue 3 (7-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(3): 193-204 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Aghamohammadi M, Khatiban M, Soltanian A, Khalili Z. Comparison of the Effect of Two Teach-Back Training and Pictorial Training Methods on Medication Adherence in Heart Failure Patients. Avicenna J Nurs Midwifery Care 2020; 28 (3) :193-204
URL: http://nmj.umsha.ac.ir/article-1-2142-en.html
1- MSc, Student Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2- Professor, Mother & Child Care Research Center, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
3- Professor, Department of Statistics, Faculty of Health, Hamadan University of Medical Sciences, Hamadan, Iran
4- Faculty Member, Research Center for Chronic Disease Care, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran , zkhalili90@yahoo.com
Persian Full-Text [PDF 564 kb]   (1409 Downloads)     |   Abstract (HTML)  (4059 Views)
Extended Abstract:   (1175 Views)
Introduction

Medicinal nonadherence prevents the achievement of therapeutic goals in cardiovascular patients. Training is essential to increase medicinal adherence. Therefore, the present study compared the effect of two teach-back and pictorial training methods on the medication adherence in heart failure patients.

 

Materials and Methods


This quasi-experimental study was performed on 210 heart failure patients in Hamadan Heart Hospital in 2019. Patients were selected by convenience sampling and randomly assigned to one of three groups of Teach-back, pictorial, and control training. Training sessions were held in three sessions on three consecutive days. Data were collected using demographic and medication adherence questionnaire (MMAS-8) before, immediately and 6 weeks after training. ANOVA, ANCOVA and Repeated measures ANOVA statistical tests were used.he present study is a descriptive-cross-sectional study of the type of correlation. Third and fourth year undergraduate nursing students (due to more attendance at bedtime) and postgraduate nursing students at Hamadan School of Nursing and Midwifery in the first semester of the academic year were 2017-2018 were considered to be the research community (123 people). Sample students were selected from the students who had the criteria to enter the study and wanted to participate in the study, as a sample of the census. In order to collect data, a three-part questionnaire including demographic questionnaire, standard questionnaire of nurses' moral sensitivity in decision making and spiritual health questionnaire was completed by the sample individuals.
The Demographic Questionnaire consists of 5 questions related to individual characteristics (including age, sex, marital status, level of education and history of participation in the ethics workshop). The standard questionnaire for nurses' ethical sensitivity in decision making was developed by Nordin, Lützén and Brolin in Sweden [25]. Then, this questionnaire was used in different countries, including Iran. The validity of this questionnaire in Iran was assessed by Hassanpoor et al., whose reliability was 0.81 [15]. Pearson correlation coefficients were analyzed. It is worth mentioning that the level of significance in this study was considered to be 0.05.


 

Results

There was no statistically significant difference between the three groups in medicinal adherence at baseline. Immediately after training, medication adherence was significantly higher in teach-back and pictorial groups than the control group (P<0.001), but there was no difference between teach back group and the pictorial group (P=0.123). Six weeks after training, medicinal adherence was significantly higher in teach-back group compared to the control and pictorial group (P<0.001). There was no significant difference between the two methods at different levels of education (P>0.05).

Table 1. Comparison of patients' demographic characteristics in three groups of control, teach-back-oriented and pictorial
Variables
 
Study groups P
Teach-Back (n=70) SD±M Pictorial (n=70) SD±M Control (n=70)
SD±M
Age (years) 8.52 ± 58.87 58.11 ± 62.14 13.06 ± 58.80 134/ a 0
BMI (kg / m2) 3.65± 26.45 4.67± 27 3.52± 26.30 a0.547
Systolic blood pressure (mmHg) 18.32± 129.31 17.68 ± 136.91 17.68±133.50 a0.056
Diastolic blood pressure (mmHg) 18.32 ± 25 /80 17.68 ± 81.58 12.62 ± 80.15 a0.723
Number of hospitalization days 1.68 ± 7.17 1.73 ± 6.95 1.84 ± 7.10 a 0.270
  N (%) N (%) N (%)  
Gender
Male
Female
 
(62.90) 44
(37.10) 26
 
(40.61) 43
(38.60) 27
 
(52.9) 37
(47.10) 33
 
 
b0.429
 Education
Illiterate
  Primary
Guidance
High-school
Diploma and above
 
(8.60) 6
(60) 42
(10) 7
(12.90) 9
(8.60) 6
 
(10) 7
(65.70) 46
(12.90) 9
(7.10) 5
(4.30) 3
 
(7.10) 5
(37.10) 26
(22.90) 16
(17.10) 12
(15.70) 11
 
 
b0.020
 Marital status
Single
Married
 
(2.90) 2
(97.10) 68
 
(11.40) 8
(88.60) 62
 
(11.40) 8
(88.60) 62
 
b 0.112
Job status
Has a job
No job
 
(64.30) 45
(35.70) 25
 
(65.70) 46
(34.30) 24
 
(61.40) 43
(38.60) 27
 
b 0.886
Smoking
Does
Does not
 
(25.70) 18
(74.30) 52
 
(30.24) 17
(75.70) 53
 
(28.60) 20
(71.40) 50
 
b 0.842
Drug use
Does
Does not
 
(11.40) 8
(88.60) 62
 
(14.30) 10
(85.70) 60
 
(15.70) 11
(84.30) 59
 
b 0.756
 
Table 2. Comparison of mean drug adherence of patients in three groups: pictorial, control and teach-back-oriented
Groups Upon arrival
SD±M
Right after training
SD±M
Six weeks after training
SD±M
Analysis of variance with repeated measures in each group Analysis of variance with repeated measures between three groups
Teach-Back 5.34± 11.37 4.62± 9.04 3.84± 6.12 182.49= F
2= df
P>0.001
 
 
 
30.01= F
2= df
* P>0.001
Pictorial 2.97± 11.04 3.10± 8.40 2.46± 9.31 23.736= F
2= df
P>0.001
Control 4.13± 11.31 4.25± 10.85 3.94± 10.98 0.65= F
2= df
P=0.519
One-way analysis of variance and covariance 0.119= F
2= df
P=0.888
15.77= F
2= df
* P>0.001
37.75= F
2= df
*P>0.001
   
* Adapted based on patients' level of education
Table 3. Comparison of the average drug adherence of patients in the studied groups based on education (score from zero to 32)
Education Groups N (%) Upon arrival
SD±M
Right after training
SD±M
Six weeks after training
SD±M
Frequently measured variance test statistics
Illiterate
 
Teach-Back (8.6) 6 2.19± 12 2± 9.50 1.50± 6.83 F=3.21
df=2
P=0.030
Pictorial (10) 7 2.03± 11.42 1.85± 7.71 1.39± 8.14
Control (7.1) 5 2.40± 12.60 2.19± 10.40 1.64± 13
Primary
 
Teach-Back (60) 42 0.59± 11.11 0.58± 8.83 0.49± 5.59 F=15.30
df=2
P>0.001
Pictorial (65.7) 46 0.56± 11.47 0.55± 8.91 0.47± 9.30
Control (37.1) 26 0.75± 12.42 0.75± 12.50 0.63± 12.30
Guidance
 
Teach-Back (10) 7 1.63± 11.85 1.58± 9 1.37± 6 F=3.54
df=2
P=0.016
Pictorial (12.9) 9 1.43± 10.33 1.40± 7.88 1.21± 9.44
Control (22.9) 16 1.07± 11.37 1.05± 11.06 0.90± 10.62
Secondary
 
Teach-Back (12.9) 9 1.54± 12 1.34± 9.66 1.30± 7.11 F=5.48
df=2
P=0.002
Pictorial (7.1) 5 2.07± 9.40 1.79± 6.40 1.75± 10.20
Control (17.1) 12 1.33± 10.33 1.16± 9.25 1.13± 10.25
Diploma Teach-Back (8.6) 6 2.17± 11 1.88± 9.16 1.58± 5.33 F=6.96
df=2
P=0.001
Pictorial (4.3) 3 3.07± 8.33 2.66± 7 2.24± 10.33
Control (15.7) 11 1.60± 9.09 1.39± 8.63 1.17± 8.27
 

Comparison of patients' mean drug adherence in three groups of control, pictorial and teach-back-oriented

Figure 1.
Comparison of patients' mean drug adherence in three groups of control, pictorial and teach-back-oriented
 

 

Discussion


According to the results, teach-back training and pictorial methods have both improved patients' drug adherence immediately after training and six weeks after training compared to the beginning of the study. In the teach-back oriented group, there was a promotion of drug adherence at each stage compared to the previous stage, but in the pictorial education group, although drug adherence increased in the six weeks after training compared to the beginning, it was not significantly different compared to immediately after training. In the control group, which received only routine training, there was no change in drug adherence immediately after training or six weeks after training.
Consistent with the results of the present study, in the review study of Dinh et al. (2016) the effectiveness of teach-back method on self-care behaviors and its maintenance in health education of patients with chronic diseases was investigated; the results showed an improvement in adherence to the drug regimen in patients in the intervention group (23).
According to the results of the present study, immediately after training, drug adherence was significantly higher in the teach-back focused and pictorial groups than the control group, but there was no difference between the teach-back focused and pictorial groups. Six weeks after training, drug adherence was significantly higher in the teach-back oriented group compared with the pictorial and control groups. In other words, the maintenance and persistence of drug adherence in the teach-back oriented group was significantly higher than the pictorial education and control group. However, in the study of Negarandeh et al. (2013), both teach-back-oriented and pictorial training methods improved drug adherence in patients with diabetes and there was no significant difference between the two methods in the six weeks after training (24).
The results of the present study showed that in people with different levels of education, teach-back-oriented and pictorial education has led to the improvement of drug adherence immediately after training and six weeks after training, but there is a statistically significant difference in terms of teach-back-oriented and pictorial training on increasing drug adherence at different levels.

 

Conclusion

Teach-back training helps maintain medicinal adherence in heart failure patients. Therefore, it is recommended that nurses use this training method to improve medicinal adherence in these patients.

 

Acknowledgments

This research has been approved by the Research Ethics Committee with the ID IR.UMSHA.REC.1397.403. The researchers thank the Vice Chancellor for Research of Hamadan University of Medical Sciences for financial support and all the officials and nurses of the wards of Farshchian Heart Hospital in Hamadan who helped us in this research.

 

Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

 

Type of Study: Original Research | Subject: Nursing
Received: 2020/02/4 | Accepted: 2020/04/13 | Published: 2020/05/30

References
1. WHO. Cardiovascular diseases Geneva: World Health Organization; 2019 [Available from: https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1.
2. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of Thoracic and Cardiovascular Surgery. 2015;149(3):e5-e23.
3. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes a meta-analysis. Medical care. 2002:794-811. [DOI:10.1097/00005650-200209000-00009] [PMID]
4. Lawrence D, Miller JH, Flexner CW. Medication Adherence. The Journal of Clinical Pharmacology. 2017;57(4):422-7. [DOI:10.1002/jcph.862] [PMID]
5. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. The American journal of medicine. 2012;125(9):882-7. e1. [DOI:10.1016/j.amjmed.2011.12.013] [PMID]
6. Zhang Y, Wu S-H, Fendrick AM, Baicker K. Variation in medication adherence in heart failure. JAMA internal medicine. 2013;173(6):468-70. [DOI:10.1001/jamainternmed.2013.2509] [PMID] [PMCID]
7. Kharameh ZT, Khoshravesh S, Noori R, Abdolmalaki M, Bakhshi M. Determinants of medication adherence among Iranian elderly patients with chronic diseases. Jundishapur Journal of Chronic Disease Care. 2018;7(3). [DOI:10.5812/jjcdc.68310]
8. Seyedfatemi N, Zeinali E, Bahremand M, Mehran A, Zeinali M. The Relationship Between Medication Adherence and Coping Skills in Patients With Heart Failure. Avicenna Journal of Nursing and Midwifery Care. 2019;27(2):89-96. [DOI:10.30699/sjhnmf.27.2.89]
9. Dianati M, Taghadosi M. Medication adherence rate and related factors in patients with acute coronary syndrome after discharge from Shahid Beheshti Hospital in Kashan during 2017-2018. KAUMS Journal (FEYZ). 2019;23(2):201-8.
10. Zare S, Shams M, Fararouei M, Shariatinia S. Antihypertensive Drugs Adherence in Heart Disease Patients Referring to the Imam Reza Clinic in Shiraz. Sadra Medical Sciences Journal. 2018;6(2):151-60.
11. Ataee M, Ahmadi-Jouybari T, Hosseini SN, Ahmadi E, Emdadi S, Farhadian M, et al. Self-care in Cardiovascular Patients: a Cross-Sectional Study in Hamadan County, the west of Iran. Journal of Biology and Today's World. 2014;3(4):68-72. [DOI:10.15412/J.JBTW.01030403]
12. Napolitano F, Napolitano P, Angelillo IF, Group CW. Medication adherence among patients with chronic conditions in Italy. The European Journal of Public Health. 2015;26(1):48-52. [DOI:10.1093/eurpub/ckv147] [PMID]
13. Bahonar A, Sarrafzadegan N, Kelishadi R, Shirani S, Ramezani MA, Taghdisi MH, et al. Association of socioeconomic profiles with cardiovascular risk factors in Iran: the Isfahan Healthy Heart Program. International journal of public health. 2011;56(1):37-44. [DOI:10.1007/s00038-010-0125-8] [PMID]
14. Downey LV, Zun LS. Assessing adult health literacy in urban healthcare settings. J Natl Med Assoc. 2008;100(11):1304-8. [DOI:10.1016/S0027-9684(15)31509-1]
15. Panagiotakos DB, Pitsavos C, Chrysohoou C, Vlismas K, Skoumas Y, Palliou K, et al. The effect of clinical characteristics and dietary habits on the relationship between education status and 5-year incidence of cardiovascular disease: the ATTICA study. European journal of nutrition. 2008;47(5):258. [DOI:10.1007/s00394-008-0720-0] [PMID]
16. Van Riet EE, Hoes AW, Wagenaar KP, Limburg A, Landman MA, Rutten FH. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. European journal of heart failure. 2016;18(3):242-52. [DOI:10.1002/ejhf.483] [PMID]
17. Yap AF, Thirumoorthy T, Kwan YH. Medication adherence in the elderly. Journal of Clinical Gerontology and Geriatrics. 2016;7(2):64-7. [DOI:10.1016/j.jcgg.2015.05.001]
18. Seyedoshohadaee M, Babaeeyan Kshtelee F, Seyyed Fatemi N, Saravi M, Haghani H. The Effect of Self-Care Education on the Resilience of the Patients With Heart Failure. JCCNC. 2018;4(3):165-72. [DOI:10.32598/jccnc.4.3.165]
19. Alligood M. Nursing Theory: Utilization and Application. 5th ed. United States: Mosby; 2014.
20. Ahmadi A, Soori H, Mehrabi Y, Etemad K, Samavat T, Khaledifar A. Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012. Eastern Mediterranean health journal. 2015;21(1):5-12. [DOI:10.26719/2015.21.1.5] [PMID]
21. Javadzade SH, Sharifirad G, Radjati F, Mostafavi F, Reisi M, Hasanzade A. Relationship between health literacy, health status, and healthy behaviors among older adults in Isfahan, Iran. Journal of education and health promotion. 2012;1. [DOI:10.4103/2277-9531.100160] [PMID] [PMCID]
22. McCormack L, Thomas V, Lewis MA, Rudd R. Improving low health literacy and patient engagement: A social ecological approach. Patient Educ Couns. 2017;100(1):8-13. [DOI:10.1016/j.pec.2016.07.007] [PMID]
23. Dinh TTH, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database System Rev Implement Rep. 2016;14(1):210-47. [DOI:10.11124/jbisrir-2016-2296] [PMID]
24. Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Prim Care Diabetes. 2013;7(2):111-8. [DOI:10.1016/j.pcd.2012.11.001] [PMID]
25. Dinh TTH, Clark R, Bonner A, Hines S. The effectiveness of health education using the teach-back method on adherence and self-management in chronic disease: a systematic review protocol. JBI Database System Rev Implement Rep. 2013;11(10):30-41. [DOI:10.11124/jbisrir-2013-900]
26. Ghanbari A, Nourozi Tabrizi K, Dalvandi A, Kavari SH, Noroozi M. Effect of an educational program based on the teach-back method on adherence to treatment regimen in dialysis patients with end stage renal disease referred to Sina Hospital during 2015-2016. Iranian Journal of Rehabilitation Research in Nursing. 2017;4(1):24-30.
27. Oliveira-Filho AD, Barreto-Filho JA, Neves SJF, Lyra Junior DPd. Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control. Arquivos brasileiros de cardiologia. 2012;99(1):649-58. [DOI:10.1590/S0066-782X2012005000053] [PMID]
28. Mehrtak M, Hemmati A, Bakhshzadeh A. Health Literacy and its Relationship with the medical, dietary Adherence and exercise in Patients with Type II Diabetes mellitus. Journal of Health Literacy. 2018;3(2):137-44.
29. Awuah-Asamoah M. Effects of Teach-Back Method of Education on Knowledge of Heart Failure Self-Care Management and Post-Discharge Knowledge Retention: George Washington University; 2019.
30. Boyde M, Peters R, New N, Hwang R, Ha T, Korczyk D. Self-care educational intervention to reduce hospitalisations in heart failure: a randomised controlled trial. European Journal of Cardiovascular Nursing. 2018;17(2):178-85. [DOI:10.1177/1474515117727740] [PMID]
31. Dinh H, Bonner A, Ramsbotham J, Clark R. Self‐management intervention using teach‐back for people with heart failure in Vietnam: A cluster randomized controlled trial protocol. Nursing & health sciences. 2018;20(4):458-63. [DOI:10.1111/nhs.12534] [PMID]
32. Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, et al. Self‐care for the prevention and management of cardiovascular disease and stroke: A scientific statement for healthcare professionals from the American Heart Association. Journal of the American Heart Association. 2017;6(9):e006997. [DOI:10.1161/JAHA.117.006997] [PMID] [PMCID]
33. Khajavi A, Moeini M, Shafiei D. The Impact of a Web-Based Family-Oriented Supportive Education Program in Adher-ence to Treatment of The Heart Failure Patients After Discharge From Hospital; A Randomized Clinical Trial. Journal of Clinical Nursing and Midwifery. 2018;7(3):286-95.
34. Vollmer WM, Owen-Smith AA, Tom JO, Laws R, Ditmer DG, Smith DH, et al. Improving adherence to cardiovascular disease medications with information technology. The American journal of managed care. 2014;20(11 Spec No 17):SP502.
35. Kazemi Majd R, Hosseini M, Safi MH, Norouzi K, Hoseinzadeh S. The Effect of Self-care Education Based on Short Message Service on Self-efficacy and Adherence to the Medication Regimen in Adolescents with Epilepsy Referred to Iran Epilepsy Association of in 2016. Journal of Nursing Education (JNE). 2017;6(4).
36. Jeffery RA, To MJ, Hayduk-Costa G, Cameron A, Taylor C, Van Zoost C, et al. Interventions to improve adherence to cardiovascular disease guidelines: a systematic review. BMC family practice. 2015;16(1):147. [DOI:10.1186/s12875-015-0341-7] [PMID] [PMCID]
37. Shariatinia S. Antihypertensive Drugs Adherence in Heart Disease Patients Referring to the Imam Reza Clinic in Shiraz. 2018.
38. Zeinali e, zeinali m, bahremand m. The Association Between Medication Adherence and Coping Sterategies in Chronic Heart Failure Patients. Avicenna Journal of Nursing and Midwifery Care. 2019;27(2). [DOI:10.30699/sjhnmf.27.2.89]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Avicenna Journal of Nursing and Midwifery Care

Designed & Developed by : Yektaweb