Self-efficacy and educational interventions in heart failure: a review of the literature.

PURPOSE The purpose of this study was to conduct a systematic review of the literature to better understand how to structure educational interventions for heart failure patients to improve their self-efficacy for self-care behaviors. METHODS A computer search of the literature from 1966 through May 2009 was conducted, yielding 84 articles. All articles were reviewed in relation to the search criteria, resulting in 12 articles that were evaluated. RESULTS Each of the reviewed studies used an intervention plus education to improve self-efficacy. Self-efficacy was a primary outcome for 7 of the studies and a secondary outcome for 5 of the studies in this literature search. Both short- and long-term interventions can improve self-efficacy demonstrating that the duration of the intervention can vary and still be successful. CONCLUSIONS Existing evidence suggests that it is not the amount of education (number of sessions/length of sessions) that improves self-efficacy, but some other factor or factors that remain unknown at present. Education delivery costs, flexibility, and the ability to more easily integrate new discoveries need to be explored. Interventions that include components specifically geared toward increasing self-efficacy for self-care in patients with heart failure are needed. Learning activities need to be incorporated into patient education programs to provide practice time that may result in behavior changes. The opportunity to practice self-care behaviors within the context of the education provided to those with heart failure, along with ongoing support, needs to be explored in future studies.