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Developing a Patient-Centred Management Program for People with Heart Failure in Jordan

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Developing a Patient-Centred Management Program for People with Heart Failure in Jordan Developing a Patient-Centred Management Program for People with Heart Failure in Jordan Osama Ahmad Alkouri Submitted for the degree of Doctor of Philosophy The University of Adelaide 2019 Table of contents Table of contents ........................................................................................................................ ii List of figures ............................................................................................................................ ix List of tables .............................................................................................................................. ix Abstract .................................................................................................................................... xii Declaration .............................................................................................................................. xiv Acknowledgements .................................................................................................................. xv Acronyms ................................................................................................................................ xvi Definitions.............................................................................................................................. xvii Chapter 1: Introduction .............................................................................................................. 1 1.1 Background to the study: Jordan ...................................................................................... 1 1.1.1 Geography of Jordan ................................................................................................. 1 1.1.2 Population of Jordan ................................................................................................. 2 1.1.3 Females in labour force in Jordan ............................................................................. 3 1.1.4 Religion in Jordan ..................................................................................................... 3 1.1.5 Jordanian health system ............................................................................................ 3 1.1.6 Political context ........................................................................................................ 7 1.2 Background to the study: heart failure ............................................................................. 7 1.2.1 Burden of heart failure .............................................................................................. 7 1.2.2 Heart failure management ......................................................................................... 8 1.3 Aims and objectives of the project................................................................................. 12 1.3.1 Study objectives ...................................................................................................... 12 1.3.2 Research questions .................................................................................................. 12 1.3.3 Significance/contribution to the discipline ............................................................. 13 1.3.4 Thesis structure ....................................................................................................... 13 Chapter 2: Literature review .................................................................................................... 15 ii 2.1 Search strategy ............................................................................................................... 15 2.2 Burden of heart failure ................................................................................................... 15 2.2.1 Burden of heart failure worldwide .......................................................................... 15 2.2.2 Burden of heart failure in the Middle East.............................................................. 16 2.3 Impact of HF on hospitalisation and readmissions ........................................................ 17 2.4 Impact of self-care on HF .............................................................................................. 17 2.5 Impact of HF on quality of life ...................................................................................... 19 2.6 Heart failure self-management ....................................................................................... 20 2.6.1 Patient education ..................................................................................................... 22 2.6.2 Post-discharge follow-up ........................................................................................ 25 2.6.3 Factors supporting heart failure management ......................................................... 30 2.7 Analysis of gaps in the research ..................................................................................... 32 2.8 Summary ........................................................................................................................ 34 Chapter 3: Methodology .......................................................................................................... 35 3.1 Mixed-methods approaches ........................................................................................... 35 3.1.1 Historical development of mixed-methods approaches .......................................... 35 3.1.2 The definition of mixed-methods research ............................................................. 36 3.1.3 The benefits and advantages of using mixed methods............................................ 36 3.1.4 Situations that benefit from utilising mixed-methods approaches .......................... 36 3.1.5 Illustrating models of mixed-methods designs ....................................................... 37 3.2 Considerations when selecting a research design .......................................................... 37 3.2.1 Timing ..................................................................................................................... 38 3.2.2 The weighting decision ........................................................................................... 38 3.2.3 The mixing decision ................................................................................................ 39 3.3 Types of mixed-methods designs................................................................................... 41 3.3.1 Concurrent triangulation ......................................................................................... 41 3.3.2 Sequential exploratory design ................................................................................. 42 iii 3.3.3 Concurrent nested ................................................................................................... 42 3.3.4 Mixed method sequential explanatory design ......................................................... 43 3.4 Pragmatism .................................................................................................................... 45 3.4.1 Philosophical assumptions of pragmatism .............................................................. 45 3.4.2 Historical overview of pragmatism ......................................................................... 45 3.4.3 Philosophical debates and beliefs around pragmatism ........................................... 46 3.4.4 Pragmatism and mixed-methods approaches .......................................................... 47 3.5 Employing a mixed-methods design in this study ......................................................... 47 3.6 Survey ............................................................................................................................ 49 3.7 The focus group method ................................................................................................ 49 3.8 The Delphi method ........................................................................................................ 50 3.9 Summary ........................................................................................................................ 51 Chapter 4: Methods for the quantitative study ......................................................................... 52 4.1 The research design........................................................................................................ 52 4.2 Sampling ........................................................................................................................ 52 4.3 Site and setting ............................................................................................................... 53 4.4 Study instruments........................................................................................................... 53 4.4.1 The Minnesota Living with Heart Failure Questionnaire (MLHFQ) ..................... 54 4.4.2 The European Heart Failure Self-Care Behaviour Scale_9 .................................... 55 4.4.3 The Medical Outcomes Study Specific Adherence Scale....................................... 55 4.4.4 Knowledge tool ....................................................................................................... 56 4.5 Piloting ........................................................................................................................... 56 4.6 Translation ..................................................................................................................... 57 4.7 Ethical considerations
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