Outcomes II| Volume 20, ISSUE 8, SUPPLEMENT , S110, August 2014

Culturally-Appropriate Education Can Improve Self-Care in Hispanic Patients with Heart Failure: A Pilot Study


      Hispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs that teach HF self-care are known to successfully reduce hospitalization rates and mortality. However, most programs are limited to patients who speak English.


      Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF, compared with usual care.


      Project Fluido (N=42) was a randomized controlled pilot trial over 3 months that included: 1 session of individualized education in Spanish using the “teach-back” method of education, nurse phone call every 2 weeks, script for calling provider, scale, and diary in the intervention group (n=22). The usual care group (n=20) received a scale and written information. Health literacy was measured using the Short Assessment of Health Literacy for Spanish Adults. Four knowledge topics were included when using teach-back: high salt foods, when to call the MD, when to report weight gain, and the use of diuretics. Self-care was measured using the Self Care Heart Failure Index and knowledge using Teach-back scores. The intervention was vetted by cultural and HF experts.


      Participants’ mean age was 57+14 years, 57% (24) were male, 64%(27) had hypertension, 86% (36) were New York Heart Association Class I-III, and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 30%(13) with 67% (28) who spoke Spanish only. Participant income was reported as <20K in 93% (39) with 38% (16) living with 4 or more in the home. Self-care and knowledge scores significantly improved (p < .001, p<.001 respectively) in the intervention group compared to usual care.


      The intervention utilized in Project Fluido was a remarkably effective method to improve HF knowledge and self-care in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges that the participants faced. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge and readmissions and mortality in Spanish-speaking patients with HF.