Developing a Culturally-Relevant Self-Care Intervention for Hispanic Adults with Heart Failure

Background: Heart failure (HF) places a disproportionate burden on ethnic minority populations, who experience poorer outcomes. Hispanics are particularly susceptible to the consequences of HF. Self-care, which encompasses adherence to diet, medication and symptom management, can significantly improve HF outcomes. Yet the availability of culturally-appropriate interventions are limited. Purpose: To culturally adapt a self-care intervention for use in a sample of Hispanic older adults with HF, translate instruments into Spanish and establish cultural relevance content validity. Methods: The ADAPT-ITT framework guided translation of a cognitive-behavioral, self-care intervention to a culturally-appropriate program for Hispanic older adults with HF. First, focus groups of Hispanic older adults with HF were conducted to elicit the reactions to existing patient education materials and guided the cultural adaptation of the intervention materials by bilingual experts. Instruments were translated into Spanish. Cultural relevance and translation accuracy were measured by calculating a modified Kappa score for each instrument. Results: Focus group feedback revealed that culturally-appropriate content that focused on favorite foods and incorporated social support was needed: My daughter prepares meals.we need to know about low salt in our food.tortillas.chorizo. Participants expressed willingness to participate in a group program and preferred a local community setting that is "easy to get to.". Translated instruments were reviewed by a panel of 7 bilingual experts and found to be culturally relevant (S-CVI Kappa scores >.77) and accurately translated for Hispanic population (Translation TS-CVI Kappa scores >.74). Discussion: The ADAPT-ITT framework is a feasible method to culturally adapt a HF self-care intervention. Since health disparities that older Hispanics with HF face are shaped by multiple socioeconomic and cultural factors, availability of a culturally-appropriate self-care intervention may facilitate the development of the skills necessary for better self-care and improve HF outcomes in ethnically-diverse populations.