Background: The incidence of heart failure is over 25 million worldwide. Despite increased awareness and public health initiatives, the rate continues to climb and the prognosis remains poor. Heart failure education at the time of discharge from hospitalization has demonstrated improved outcomes. Computer-based learning strategies are a relatively novel approach to patient education in the population of adults hospitalized with heart failure. To date, the evidence regarding the efficacy of this approach in the hospitalized heart failure patient has not been reviewed systematically.
Objectives: The objective of this systematic review was to identify the best available evidence on the effectiveness of computer-based learning in hospitalized adults with heart failure, on knowledge, re-admission, self-care, quality of life and patient satisfaction.
Inclusion criteria: Types of participants
All adults of any ethnicity, race or gender, aged 18 years or older who were hospitalized with a primary or secondary diagnosis of heart failure with or without existing comorbidities.
Types of intervention(s)
Studies that evaluated computer-based learning focusing on heart failure education in the hospital setting prior to discharge, compared with standard education such as face-to-face instructions with individuals or groups, using written educational materials administered by healthcare professionals.
Types of studies
Randomized controlled trials and quasi-experimental studies.
Types of outcomes
This review considered studies that included the primary outcome measure of knowledge and the secondary outcomes of readmission, self-care, quality of life and patient satisfaction.
Search strategy: Published and unpublished studies in the English Language from 1970 through October 2013. A search of PubMed, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, Healthsource: Nursing/Academic edition, Academic Search Premiere and ERIC was conducted. A search for grey literature was also performed.
Methodological quality: Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute.
Data collection and synthesis: Standardized data extraction tools were used as per the Joanna Briggs Institute for data extraction. Statistical meta-analysis was not possible due to the limited studies reviewed.
Results: Two studies exploring computer-based learning were considered in this review, which included one randomized controlled trial and one quasi-experimental study. The randomized controlled trial looked at the effects of computer-based learning on readmission and knowledge, while the quasi-experimental study explored the impact of computer-based learning on knowledge and self-care. Both studies used standard heart failure education as the control. The quasi- experimental study did not show any statistically significant differences in knowledge or self-care between groups. The randomized controlled trial demonstrated significantly higher knowledge scores in the intervention group with no effect on readmission rates.
Conclusions: The effect of computer-based learning strategies on knowledge, re-admission, self-care, QOL and patient satisfaction has yet to be determined.
Implications for practice
There is limited evidence that computer-based learning delivered to HF patients prior to discharge improves patient outcomes. Health providers considering computer-based learning instead of standard face to face education prior to discharge for HF patients should be aware there is currently no evidence to support this intervention.
Implications for research
Future studies are needed to evaluate computer-based learning as a single intervention compared to standard education. Clinical trials with larger sample sizes comparing various modes independently might assist in guiding future computer applications. In addition, research should include assessment of patient readiness to learn, learning styles and literacy levels.