Introduction
Materials and methods
Study design
Participants
Heart valve surgery patients
Inclusion criteria
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an age range of 18 to 65 years,
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having an Android smartphone,
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undergoing mechanical heart valve replacement surgery for the first time,
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and not having auditory, visual,or tactile disorders.
Exclusion criteria
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suffering from any other physical illnesses than heart valve disease,
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having well-known physical or mental disorders (i.e., dialysis, depression, schizophrenia),
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entering the acute phase of the disease,
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re-hospitalization, and death of the patient.
Caregivers
Inclusion criteria
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not being a member of a medical or treatment team,
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caring for a patient at least twice a week,
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being a first-degree family member of the patient,
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having at least a minimum level of literacy,
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and caring for a patient undergoing heart valve replacement surgery for the first time.
Exclusion criteria
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Caregivers` patients dying during the study,
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previously participating in education sessions related to this research,
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taking care of another patient in addition to the patient suffering from heart valve surgery,
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having a known mental disorder,
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and being a healthcare worker.
Sample size
Randomization and blinding
Educational material
Section | Content of the App | Aim | Method |
---|---|---|---|
1 | Overview of heart valve failure and dysfunction, etiology, signs and symptoms, prevention and diagnosis Familiarity with medications, the need to use them, and their possible side effects The importance of careful use of drugs in case of disease exacerbation and prevention of re-hospitalization | To better understand the disease, its signs, symptoms, diagnosis, and the need to prevent it, Increase the knowledge of medications, their necessity, and their side effects | Using the smartphone application Question and answer during telephone follow-up |
2 | Explanation on how to properly take care of themselves and its aspects Explanation of the importance of managing patients' signs and symptoms in emergency cases Explanation of the importance and necessity of changing the patient's lifestyle, including following a proper diet, movement and exercise, following a medication schedule, quitting smoking, and controlling weight | Improving the patient's self-care ability Increasing the patient's knowledge and skill to control the condition | Using the smartphone application Question and answer during telephone follow-up |
3 | Discussion on how to adapt to the disease for patients | Promotion and improvement of strategies | Using the smartphone application Question and answer during telephone follow-up |
4 | Following up on the educational and support needs of the patient Answering the questions | Meeting the unique educational and support needs of patients and providing guidance | Using the smartphone application Question and answer during telephone follow-up |
Ethical considerations
Intervention
Control
Instrumentation
Patients' demographic questionnaire
Caregivers' demographic questionnaire
The Sullivan Self-Efficacy Questionnaire
Caregiver Burden Inventory (CBI)
Statistical analysis
Findings
Demographic characteristics
Variable | Category | Test | Control | ||
---|---|---|---|---|---|
Number | Percentage | Number | Percentage | ||
Age (years) | 20–35 years | 2 | 6.7 | 3 | 10 |
36–50 years | 10 | 33.3 | 12 | 40 | |
51–65 Years | 18 | 60 | 15 | 50 | |
Standard deviation ± mean | 52.50 ± 10.13 | 49.20 ± 10.12 | |||
P*=0.212 | |||||
Gender | Man | 21 | 70 | 18 | 60 |
Woman | 9 | 30 | 12 | 40 | |
P**=0.589 | |||||
Marital status | Single | 2 | 6.7 | 3 | 10 |
Married | 28 | 93.3 | 27 | 90 | |
P**=1 | |||||
Job | Employee | 1 | 3.3 | 2 | 6.7 |
Freelance job | 17 | 56.7 | 16 | 53.3 | |
Retired | 2 | 6.7 | 4 | 3/13 | |
Worker | 1 | 3.3 | 0 | 0 | |
Housewife | 9 | 30 | 8 | 26.7 | |
P**=0.865 | |||||
Education level | Elementary and the literacy movement | 1 | 3.3 | 0 | 0 |
Undergraduate | 13 | 43.3 | 11 | 36.7 | |
Diploma | 8 | 26.7 | 7 | 23.3 | |
Associate and Bachelor's Degrees | 8 | 26.7 | 12 | 40 | |
P**=0.606 | |||||
Replaced valve | Mitral | 14 | 46.7 | 12 | 40 |
Aorta | 14 | 46.7 | 15 | 50 | |
Tricuspid | 2 | 6.7 | 3 | 10 | |
P**=0.864 |
Variable | Category | Test | Control | ||
---|---|---|---|---|---|
Number | Percentage | Number | Percentage | ||
Age (years) | 20–35 years | 6 | 20 | 4 | 13.3 |
36–50 years | 11 | 36.7 | 19 | 63.3 | |
51–65 years | 13 | 43.3 | 7 | 23.3 | |
Mean ± standard deviation | 46.00 ± 10.84 | 44.06 ± 8.56 | |||
P*=0.447 | |||||
Gender | man | 15 | 50 | 15 | 50 |
woman | 15 | 50 | 15 | 50 | |
P***=1 | |||||
Relationship of family member to patient | Wife | 18 | 60 | 19 | 63.3 |
Boy | 8 | 26.7 | 5 | 16.7 | |
Girl | 2 | 6.7 | 3 | 10 | |
Father | 2 | 6.7 | 2 | 6.7 | |
Brother | 0 | 0 | 1 | 3.3 | |
P**=0.88 | |||||
Marital status | Single | 5 | 16.7 | 3 | 10 |
Married | 25 | 83.3 | 27 | 90 | |
P**=0.706 | |||||
Education level | Elementary | 1 | 3.3 | 0 | 0 |
Undergraduate | 8 | 26.7 | 9 | 30 | |
Diploma | 8 | 26.7 | 10 | 33.3 | |
Associate's and Bachelor's degrees | 13 | 43.3 | 11 | 36.7 | |
P**=0.847 | |||||
Job | Employee | 9 | 30 | 8 | 26.7 |
Free | 1 | 36.7 | 12 | 40 | |
Housewife | 10 | 33.3 | 10 | 33.3 | |
P***=1 |
Heart valve surgery patients' self-efficacy
Self-efficacy | Before the intervention | After the intervention | Paired t-test result | ||||
---|---|---|---|---|---|---|---|
Group | Average | Standard deviation | Average | Standard deviation | |||
Test | 29.90 | 4.60 | 47.43 | 5.43 | P < 0.001 | df = 29 | t = −13.84 |
Control | 30.26 | 5.45 | 32.23 | 3.25 | 0.094 = P | df = 29 | t = −1.72 |
Independent t-test result | t = −0.28 df = 58 P = 0.780 | t = 13.14 df = 58 P < 0.001 |
Caregiver burden
Care burden | Before the intervention | After the intervention | Paired t-test result | ||||
---|---|---|---|---|---|---|---|
Group | Average | Standard deviation | Average | Standard deviation | |||
Test | 53.60 | 4.23 | 45.33 | 6.34 | P < 0.001 | df = 29 | t = 5.57 |
Control | 54.30 | 6.81 | 53.86 | 6.80 | 0.157 = P | df = 29 | t = 1.45 |
Independent t-test result | t = −0.47 df = 58 P = 0.635 | t = −5.02 df = 58 P < 0.001 |