A systematic Review of the Mediating Role of Knowledge, Self-efficacy and Self-care Behaviour in Telehealth Patients with Heart Failure
Abstract
We conducted a systematic review of controlled trials and pre-post studies to examine whether the putative benefits of telehealth, notably, improvements in clinical outcomes and quality of life, are mediated by increases in knowledge, self-efficacy and self-care behaviour in patients with heart failure. Telehealth was defined as any system of home-based self-monitoring of signs or symptoms of heart failure that transferred data for remote assessment by healthcare providers. Seven electronic databases were searched for studies that assessed any of six pathways in a proposed model. Data were independently extracted by two reviewers. Twelve studies met the inclusion criteria and provided evidence for or against one or more of the six pathways. Although all of the pathways in the model can be theoretically justified and three of the six relationships have been established in heart failure samples outside the context of telehealth, none of the pathways in the model were supported by the telehealth studies reviewed. Failure to replicate previously established relationships emphasizes the weakness of the telehealth literature, which impedes our ability to address questions such as how telehealth might achieve beneficial outcomes.
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Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars, 23 received 2 stars, 21 received 1 star, and 1 received no stars.
“Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars [16,21,25,26,38,45,53,56], 23 received 2 stars [22,24,27-31, 33,37,40,42,44,46,49,50,52,54,55,58,62,63,67,68], 21 received 1 star [19,20,23,32,34-36,39,43,47,48,51,57, 59-61,64-66,69,70], and 1 received no stars [41].”
The highest weighted heart failure review (Ciere et al, 3 stars) did not include any disease control outcomes, nor did three others.
“The highest weighted of these (Ciere et al, 3 stars) did not include any disease control outcomes [56], nor did 3 others [16,59,60].”
Nine reviews analyzed telehealth interventions for heart failure.
“A total of 9 reviews analyzed telehealth interventions for heart failure [16,20,28,55-60].”
Ciere et al found that evidence linking telehealth interventions with increased knowledge or self-care behaviors, or linking self-efficacy with self-care, was ambiguous.
“They found that evidence linking telehealth interventions with increased knowledge or self-care behaviors, or linking self-efficacy with self-care was “ambiguous,” and concluded that, on the basis of their findings and the poor methodological quality of the included studies, the evidence neither supports nor refutes their models [56].”
Ciere et al specifically analyzed whether the beneficial effects of telehealth interventions on clinical outcomes were mediated by increases in knowledge, self-care, or self-efficacy.
“The highest weighted of the heart failure reviews (Ciere et al) specifically analyzed whether the beneficial effects of telehealth interventions on clinical outcomes were mediated by increases in knowledge, self-care, or self-efficacy [56].”
Ciere et al concluded that the evidence neither supports nor refutes their models.
“They found that evidence linking telehealth interventions with increased knowledge or self-care behaviors, or linking self-efficacy with self-care was “ambiguous,” and concluded that, on the basis of their findings and the poor methodological quality of the included studies, the evidence neither supports nor refutes their models [56].”
In heart failure, evidence linking knowledge, self-efficacy, or self-care behaviors to improvements in disease outcomes was either lacking or inconsistent.
“In heart failure, evidence linking knowledge, self-efficacy, or self-care behaviors to improvements in disease outcomes was either lacking or inconsistent [56].”
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- Authors
- Ciere, Y., Cartwright, M., & Newman, S. P.
- Affiliations
- Leiden University (NL)
- City, University of London (GB)
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2012-09-27
- Volume
- 18
- Issue
- 7
- Pages
- 384-391
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- OpenAlex
- W2063295917
- Cited by
- 50
- References
- 46
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 6 · 2014: 4 · 2013: 3
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Telemedicine and Telecare (publishedVersion)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- telemedicine, heart failure, self-efficacy, self-care behavior, patient knowledge, mediation, quality of life, clinical outcomes, replication failure
- MeSH terms
- Aged, Female, Heart Failure, Humans, Male, Middle Aged, Patients, Self Care, Telemedicine, Self Efficacy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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