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Jaarsma, Tiny, ProfessorORCID iD iconorcid.org/0000-0002-4197-4026
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Publications (10 of 317) Show all publications
Johansson, P., Westas, M., Andersson, G., Alehagen, U., Broström, A., Jaarsma, T., . . . Lundgren, J. (2019). An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial. JMIR mental health, 6(10), Article ID e14648.
Open this publication in new window or tab >>An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial
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2019 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 6, no 10, article id e14648Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression.

OBJECTIVE: The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD.

METHODS: A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire-9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale-self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models.

RESULTS: Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=-2.34 [95% CI -3.58 to -1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression.

CONCLUSIONS: Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074.

Place, publisher, year, edition, pages
Toronto, Canada: J M I R Publications, Inc., 2019
Keywords
cardiovascular disease, cognitive behavior therapy, depression, internet, randomized controlled trial
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-161243 (URN)10.2196/14648 (DOI)000489649600001 ()31584000 (PubMedID)2-s2.0-85073221407 (Scopus ID)
Note

Funding agencies: Swedish Research CouncilSwedish Research Council [2015-02600]; ALF grant Region Ostergotland [LIO-600321, LIO-687531]; ALF grant Region Ostergotland, Strategic fund [LIO-719561]

Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2019-12-09Bibliographically approved
Perkiö Kato, N., Jaarsma, T., Casida, J. M., Lee, C. S., Strömberg, A. & Ben Gal, T. (2019). Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation.. Progress in transplantation, 29(4), 335-343, Article ID 1526924819874358.
Open this publication in new window or tab >>Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation.
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2019 (English)In: Progress in transplantation, ISSN 2164-6708, Vol. 29, no 4, p. 335-343, article id 1526924819874358Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.

METHODS: We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.

RESULTS: A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.

CONCLUSION: The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
heart failure, instrument, mechanical circulatory support, patient-reported outcomes, scale development
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-161720 (URN)10.1177/1526924819874358 (DOI)000495794200007 ()31570068 (PubMedID)
Available from: 2019-11-07 Created: 2019-11-07 Last updated: 2019-11-27Bibliographically approved
Ben Gal, T., Perkiö Kato, N., Yaari, V., Avraham, B., Klompstra, L., Strömberg, A. & Jaarsma, T. (2019). Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale. Heart, Lung and Circulation, Article ID S1443-9506(19)31523-9.
Open this publication in new window or tab >>Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale
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2019 (English)In: Heart, Lung and Circulation, ISSN 1443-9506, E-ISSN 1444-2892, article id S1443-9506(19)31523-9Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.

AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.

METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.

RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.

CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Heart failure, Measurement, Reliability, Validity
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-162853 (URN)10.1016/j.hlc.2019.10.019 (DOI)31862228 (PubMedID)2-s2.0-85076848868 (Scopus ID)
Available from: 2019-12-25 Created: 2019-12-25 Last updated: 2020-03-26Bibliographically approved
Verheijden Klompstra, L., Johansson Östbring, M., Jaarsma, T., Ågren, S., Fridlund, B., Hjelm, C., . . . Strömberg, A. (2019). The Appropriateness and Presentation of Commonly Available Cardiovascular Web Pages Providing Information About Cardiovascular Diseases.. Computers, Informatics, Nursing, 37(10), 493-497
Open this publication in new window or tab >>The Appropriateness and Presentation of Commonly Available Cardiovascular Web Pages Providing Information About Cardiovascular Diseases.
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2019 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 37, no 10, p. 493-497Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-161240 (URN)10.1097/CIN.0000000000000595 (DOI)31633511 (PubMedID)
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2020-02-03
van der Wal, M. H. L., Waldréus, N., Jaarsma, T. & Perkiö Kato, N. (2019). Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan. Journal of Cardiovascular Nursing
Open this publication in new window or tab >>Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan
2019 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Thirst is a distressing symptom and influences quality of life of patients with heart failure (HF). Knowledge about thirst in HF is insufficient; therefore, the aim of this study was to describe factors related to thirst, self-reported reasons for thirst, and interventions to relieve thirst in 3 different countries.

METHODS: A cross-sectional study was conducted in Sweden, the Netherlands, and Japan. Patients were recruited at the HF clinic or during HF hospitalization. Thirst was assessed by a visual analog scale (0-100); reasons for thirst and interventions to relieve thirst were assessed by an open-ended questionnaire. Patients were divided into low and high thirst based on the first and third tertiles of the visual analog scale.

RESULTS: Two hundred sixty-nine patients participated in the study (age, 72 ± 12 years). Mean thirst intensity was 24 ± 24, with a mean thirst of 53 ± 15 in the highest tertile. No significant differences in thirst among the 3 countries were found. Multivariable logistic regression analysis showed that a higher dose of loop diuretics (odds ratio, 3.47; 95% confidence interval, 1.49-8.06) and fluid restriction (odds ratio, 2.21; 95% confidence interval, 1.08-4.32) were related to thirst. The most reported reasons for thirst were salty/spicy food (20%) and low fluid intake (18%). Most of the patients (56%) drank more in case of thirst; 20% only drank a little bit, probably related to a fluid restriction.

CONCLUSIONS: Thirst in patients with HF was related to a higher dose of loop diuretics and fluid restriction. Healthcare providers should realize that it is important to assess thirst regularly and reconsider the need of a fluid restriction and the amount of loop diuretics in case of thirst.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-161721 (URN)10.1097/JCN.0000000000000607 (DOI)31441802 (PubMedID)
Available from: 2019-11-07 Created: 2019-11-07 Last updated: 2020-03-26Bibliographically approved
Jaarsma, T. & Strömberg, A. (2019). We told you so: knowledge is not enough to improve heart failure self-care behaviour. ESC Heart Failure
Open this publication in new window or tab >>We told you so: knowledge is not enough to improve heart failure self-care behaviour
2019 (English)In: ESC Heart Failure, E-ISSN 2055-5822Article in journal, Editorial material (Refereed) Epub ahead of print
Abstract [en]

n/a

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-160422 (URN)10.1002/ejhf.1580 (DOI)000483562500001 ()31452305 (PubMedID)2-s2.0-85071650967 (Scopus ID)
Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-10-01Bibliographically approved
Mourad, G., Verheijden Klompstra, L., Jaarsma, T., Strömberg, A. & Alwin, J. (2019). What are patients with heart failure willing to pay for an exergame intervention?. In: : . Paper presented at EuroHeartCare.
Open this publication in new window or tab >>What are patients with heart failure willing to pay for an exergame intervention?
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2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Regular physical activity in patients with heart failure (HF) improves physical capacity and quality of life, and may reduce health care utilization. One low-cost effective physical activity intervention to increase exercise capacity is exergaming. Exploring patients’ willingness to pay (WTP) for treatments/interventions is a way to obtain a monetary value for the health consequences of an intervention. This can further be used in economic evaluations.

Aim: The aim of this study was to describe patients´ WTP for an exergame intervention and to determine factors influencing the WTP.

Methods: This is a substudy of the Swedish cohort of the HF-Wii study (evaluating the effect of exergaming on exercise capacity in patients with HF; clinicaltrial.gov NCT01785121) including 34 patients who finished the 1-year follow-up. Structured telephone interviews were conducted focusing on WTP for the exergame intervention they received during the study including an exergame platform, an introduction lesson, installation of the exergame computer, and telephone follow-ups, and with an estimated cost of ∼€440 per patient. The WTP methodology used was adjusted for this specific study.

Patients were also asked to rate their level of satisfaction with the intervention on a Numeric Rating Scale (NRS) from 0-10. In addition, information on background variables and income was collected during the interview, while data on six minute walk test (6MWT) and quality of life was retrieved from previous data collection in the main study.

Results: In total, 29 patients with HF participated in this substudy, mean age 68±9 years, 69% males, and with a mean household disposable income/month of ∼€2700 (±1360). Ten patients (34.5%) had a clinically significant effect of the exergaming and improved more than 30 meters on the 6MWT.

The average WTP for the exergame intervention was ∼€160 (range €0-580). Most patients were satisfied with the exergame intervention and the median score was 8 on the NRS. The satisfaction level was significantly related to WTP (rs=0.468, p=0.012). Patients with higher satisfaction levels were willing to pay more (€210±165) for the exergame intervention than those with lower satisfaction levels (€60±70), p=0.015. Income, changes in 6MWT, and quality of life showed no significant relationship to WTP.

Conclusions: The WTP for an exergame intervention varied largely in patients with HF despite high satisfaction level with the intervention. The satisfaction level was the only factor influencing patients´ WTP. On average, patients were willing to pay about one-third of the cost of the exergame intervention. Future studies should focus on the cost-effectiveness of this intervention.

National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-158027 (URN)
Conference
EuroHeartCare
Available from: 2019-06-24 Created: 2019-06-24 Last updated: 2019-09-16
Säfström, E., Jaarsma, T. & Strömberg, A. (2018). Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization. BMC Geriatrics, 18, Article ID 177.
Open this publication in new window or tab >>Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization
2018 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 177Article in journal (Refereed) Published
Abstract [en]

Background: The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients perspective and from a medical chart review. Methods: This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearmans rank correlation coefficient and Chi square. A P value of 0. 05 was considered significant. Results: A total of 121 patients were included in the study, mean age 82.5 (+/- 6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. Conclusion: Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Heart failure; Health care utilization; Hospitalization; Continuity of care; Discharge; Elderly patients
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-150865 (URN)10.1186/s12877-018-0861-9 (DOI)000441406000001 ()30103688 (PubMedID)
Note

Funding Agencies|Linkoping University; Sormland County Council

Available from: 2018-09-06 Created: 2018-09-06 Last updated: 2019-06-27
Waldreus, N., Jaarsma, T., van der Wal, M. & Perkiö Kato, N. (2018). Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure. European Journal of Cardiovascular Nursing, 17(3), 226-234
Open this publication in new window or tab >>Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure
2018 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 3, p. 226-234Article in journal (Refereed) Published
Abstract [en]

Background:

Patients with heart failure can experience thirst distress. However, there is no instrument to measure this in patients with heart failure. The aim of the present study was to develop the Thirst Distress Scale for patients with Heart Failure (TDS-HF) and to evaluate psychometric properties of the scale.

Methods and results:

The TDS-HF was developed to measure thirst distress in patients with heart failure. Face and content validity was confirmed using expert panels including patients and healthcare professionals. Data on the TDS-HF was collected from patients with heart failure at outpatient heart failure clinics and hospitals in Sweden, the Netherlands and Japan. Psychometric properties were evaluated using data from 256 heart failure patients (age 72±11 years). Concurrent validity of the scale was assessed using a thirst intensity visual analogue scale. Patients did not have any difficulties answering the questions, and time taken to answer the questions was about five minutes. Factor analysis of the scale showed one factor. After psychometric testing, one item was deleted. For the eight item TDS-HF, a single factor explained 61% of the variance and Cronbach’s alpha was 0.90. The eight item TDS-HF was significantly associated with the thirst intensity score (r=0.55, p<0.001). Regarding test-retest reliability, the intraclass correlation coefficient was 0.88, and the weighted kappa values ranged from 0.29–0.60.

Conclusion:

The eight-item TDS-HF is valid and reliable for measuring thirst distress in patients with heart failure.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Thirst distress; heart failure; scale
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-147585 (URN)10.1177/1474515117728624 (DOI)000429799300005 ()28838260 (PubMedID)2-s2.0-85041391093 (Scopus ID)
Note

Funding Agencies|Riksforbundet-HjartLung [E100/13]; Stockholms lans landsting (Pick-Up project); Svensk Sjukskoterskeforening; Japan Society for the Promotion Science KAKENHI [JP25893059]

Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2019-11-07Bibliographically approved
Kraai, I. H., Vermeulen, K. M., Hillege, H. L. & Jaarsma, T. (2018). "Not getting worse": a qualitative study of patients perceptions of treatment goals in patients with heart failure. Applied Nursing Research, 39, 41-45
Open this publication in new window or tab >>"Not getting worse": a qualitative study of patients perceptions of treatment goals in patients with heart failure
2018 (English)In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 39, p. 41-45Article in journal (Refereed) Published
Abstract [en]

Background Knowledge of patient reported outcomes helps to provide personalized care on a patient level, optimize care on a population level, and identify the most appropriate patient reported outcomes for clinical trials. To be able to provide personalized care to patients with HF, it is important to know which treatment goals patients with HF consider the most important. This is particularly useful for interventions aimed at improving symptoms, functional status, or health-related quality of life. Aim: The aim of this study was (1) to explore which treatment goals patients with heart failure (HF) perceive as important for their treatment and (2) to identify which treatment goals take priority over other treatment goals. Methods: The study had a qualitative design and included one focus group interview with 6 patients with HF. Data were analyzed using qualitative content analysis. Results: The overall theme of this study was found to be Not getting worse. This theme was composed of 4 categories that described how the patients perceived the goals of treatment: to decrease symptoms, to improve physical function, to prevent readmission, and to live a normal life. None of the participants mentioned improved survival or being cured of their HF as a treatment goal. Conclusion Not getting worse was perceived as the treatment goal that matters to patients with HF and is in line with currently used endpoints for the evaluation of a treatment in a clinical trial. More research is necessary to develop endpoints that are consistent with the perception of patients, useful for clinical practice, and measurable.

Place, publisher, year, edition, pages
Saunders Elsevier, 2018
Keywords
Cardiovascular; Focus group; Patient centered care; Qualitative; Heart failure
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-145774 (URN)10.1016/j.apnr.2017.10.010 (DOI)000425838500007 ()29422175 (PubMedID)
Note

Funding Agencies|Dutch Ministry of Health, Welfare, and Sport

Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2019-06-27
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4197-4026

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