USING TECHNOLOGY TO PROMOTE SELF-MANAGEMENT IN AGING AFRICAN AMERICAN W/ HEART FAILURE
Background. According to the Centers of Disease Control and Prevention (CDC) African Americans (AA) and older individuals are at high risk for cardiovascular disease (CVD). Nearly 44% of AA men and 48% of AA women have some form of CVD including heart failure. Assuring the best outcomes for heart failure requires patients to active engage in self-management practices. Yet, sustained engagement with self-management practices remains a challenge. Both self-management practices and clinical outcomes differ by race, with the poorest self-management and clinical outcomes reported in AAs. Some intervention studies on self-management have used technological innovations, such as text messaging, social networking, and online learning platforms. The degree to which these innovations have been studied among older AAs with heart failure is unknown.
Method. A literature search was conducted using CINAHL, PubMed and Google Scholar databases. The following keywords were used: African Americans, Blacks, Heart disease, Heart failure, Technology, Lifestyle changes, Self-management, Self-care, Technology, Text messaging, Telemedicine, e-Health, m-Health, Email, Internet, Web, Cell phone, Mobile technology, Patient education, Social networking, and Social support. Data were analyzed for methodological strengths and for focus on elder AAs with heart failure
Results. Few studies evaluated use of technology for self-management in AA. The consensus of the literature review was that social norms, cultural beliefs, and cultural preferences significantly influence self-care practices of many AAs. Although there were similarities, findings and generalizability differed significantly. Because two studies had small convenience samples and did not include control groups, conclusions from these intervention studies cannot be generalized. One study included randomization and a control group, but the short study duration (30 days) did not allow for evaluation of treatment sustainability. Despite these limitations, the studies suggest significant implications for the future of research regarding using technology to facilitate heart failure self-management in AAs. The findings were useful in the process of evaluating effect on outcomes such as function, mood and disease progression, as well as acceptability and feasibility of use.
Conclusion. The literature specific to AA is limited. Interventions such as text messaging programs, online programs for education and monitoring, and social networking platforms provide synchronous and asynchronous education and support that are necessary for successful heart failure self-management. They may also significantly enhance patient and caregiver engagement and improve clinical outcomes. However, the feasibility and acceptability of technology use among older AA or those living in poverty still requires elucidation.
Implications. Using technology may increase compliance with self-management plans in AAs with heart failure. Receiving emails or text messages may increase the patient’s ability to remember exact timing of medications and daily blood pressure screenings. Nurses can take an active role in loading the technology into the gadgets and educating patients how to use it effectively. More studies are needed to determine how to remove barriers for AAs living in poverty who may not have access to computers, phones, or other technology health tools.