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Qi-Liang Zhang, Yu-Qing Lei, Jian-Feng Liu, Hua Cao, Qiang Chen, Using telemedicine to improve the quality of life of parents of infants with CHD surgery after discharge, International Journal for Quality in Health Care, Volume 33, Issue 3, 2021, mzab133, https://doi.org/10.1093/intqhc/mzab133
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Abstract
The purpose of this study was to investigate the effect of using telemedicine to improve the quality of life of parents of infants with congenital heart disease (CHD) surgery after discharge.
A prospective randomized controlled study was conducted in a provincial hospital in China from November 2020 to April 2021 to compare the quality of life of parents of infants with CHD surgery after discharge between the WeChat follow-up group and the outpatient follow-up group. A total of 84 patients (42 in each group) and 168 parents (84 in each group) participated in this study.
One month after discharge, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of parents in the intervention group were significantly lower than those in the control group (P < 0.05). Compared with the SAS and SDS scores at discharge, the scores of parents in the intervention group were significantly lower at 1 month after discharge (P < 0.05), while the scores of parents in the control group were similar at 1 month after discharge (P > 0.05). At discharge, in both the intervention group and the control group, the SAS and SDS scores of the mothers were higher than those of the fathers (P < 0.05). One month after discharge, in the control group, the SAS and SDS scores of the mothers were higher than those of the fathers (P < 0.05). One month after discharge, in the intervention group, the SAS and SDS scores of the mothers were similar to those of the fathers (P > 0.05). The comparison of the SAS and SDS scores of parents with different education levels showed that in both the intervention group and control group, the lower the parents’ educational levels, the higher their SAS and SDS scores (P < 0.05). One month after discharge, in the control group, the lower the parents’ education levels, the higher their SAS and SDS scores (P < 0.05). One month after discharge, in the intervention group, the SAS and SDS scores were similar among parents with different educational levels. The results of the World Health Organization Quality of Life Brief scale showed that the scores of the physiological, psychological, social and environmental fields at 1 month after discharge in the intervention group were significantly higher than those in the control group (P < 0.05).
Providing health education and medical support to the parents of infants with CHD surgery after discharge via telemedicine can effectively relieve parents’ anxiety and depression and improve their quality of life.
Introduction
Congenital heart disease (CHD) is the most common congenital structural malformation in children, with a prevalence rate of 8 per 1000 live births [1, 2]. Complications such as cardiac insufficiency, arrhythmia, pulmonary infection and malnutrition easily occur after CHD surgery [3]. These patients need professional medical support, meticulous care and close follow-up after discharge to reduce the occurrence of complications [4]. After discharge, the parents need to independently care for the infants after CHD surgery without the high-quality medical support of the hospital, and the stress of caring for the infants can last for weeks, months or even years, which leads to a decline in the parents’ physical and mental health and quality of life [5].
An increasing number of studies have demonstrated the feasibility and clinical benefits of using telemedicine to support patients with chronic diseases at home [6, 7]. Many studies have shown that telemedicine can extend high-quality medical services from hospitals to families, and it is not limited by time and place. Telemedicine can effectively improve the prognosis of patients, enhance parents’ care abilities, reduce parents’ care burdens and improve their quality of life [8–10]. We conducted a prospective randomized controlled study to investigate the effect of using telemedicine to alleviate anxiety and stress and improve the quality of life of parents of infants with CHD after surgery.
Methods
The present study was approved by the ethics committee of our hospital and adhered to the tenets of the Declaration of Helsinki. Additionally, all the parents of the patients signed the consent form before participating in the study.
Research design
A prospective randomized controlled study was conducted in Fujian Maternity and Child Health Hospital on the southeast coast of China from November 2020 to April 2021. Based on the results of the World Health Organization Quality of Life Brief (WHOQOL-BREF) scale from the pre-experiment and assuming that the alpha value was set at 0.05 with a power of 0.80, the required number of participants was calculated to be 38 for each group. Assuming a 10% missing rate, the total sample size was set as 84 (42 participants per group).
A total of 84 patients (42 in each group) and 168 parents (84 in each group) participated in this study. The parents of all the patients completed the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) at the time of discharge and completed the SAS scale, SDS scale and WHOQOL-BREF scale again at the 1-month follow-up.
The inclusion criteria were as follows: (i) infants that had undergone CHD surgery; (ii) the infants’ parents were the primary caregivers; (iii) the parents had smartphones and could use WeChat properly and (iv) the internet was easy to use at home. The exclusion criteria were as follows: (i) infants that had other serious diseases; (ii) infants that experienced postoperative death and (iii) the parents of the infants that refused to participate in the study.
Recruitment
All parents of enrolled participants were informed of the research objectives, the study procedures, and their rights and obligations. All parents of enrolled participants were asked to complete written consent. Withdrawal from the study was possible at any time without any negative consequences.
Randomization
Participants who were eligible were randomized to either the intervention group or the control group by an independent member of our research team using a 1:1 randomization ratio and a randomization list blinded to the researchers (Figure 1).
Telemedicine tool
WeChat (Tencent Ltd., Shenzhen, China) is a popular smartphone-based social media application such as Facebook, Twitter and WhatsApp. WeChat is a convenient and intuitive method of information exchange, and it integrates functions such as graphics, text, audio and video to maximize information coverage. WeChat is the most popular mobile social media application in China, with 1.12 billion users, and it has become an ideal platform for health education [11].
Intervention methods
The parents in the intervention group were provided with health education and care guidance at home via WeChat. At the time of discharge, parents were guided in joining the WeChat platform and taught to use WeChat functions correctly and skillfully. The health education content in the WeChat intervention group included two parts, the education module and the question and answer module, described as follows: (i) the education module included related knowledge on CHD, postoperative care, family care, feeding and management of complications. Parents could view the module and learn at any time that was convenient for them. (ii) The question and answer module included one medical staff member of our team that was on duty every day and was online in the WeChat group from 18:00 to 21:00 to address parents’ problems. The medical staff also guided the family members to communicate, discuss and share their care experiences and encourage each other actively in the WeChat intervention group.
The parents in the control group were provided a leaflet at discharge. The leaflet contained the same educational information that was given to the intervention group. The parents in the control group were also told to visit the hospital immediately in the event of an emergency.
Research tool
The SAS comprised 20 items. Fifteen items were presented with negative wording. The scores were obtained using the scoring method in ascending order (1 to 4) based on the frequency of symptom occurrence. Five items were presented with positive wording. The scores were obtained using the reverse scoring method in descending order (4 to 1) based on the frequency of symptom occurrence. The total score was obtained by adding the scores of all items. The standard score was obtained by multiplying the total score by 1.25 and rounding the result. The mean value of the standard score was 50. With regard to the grade description, 50–59 indicated mild anxiety, 60–69 indicated medium anxiety and ≥70 indicated severe anxiety [12].
The SDS comprised 20 items, including 10 negative symptoms and 10 positive symptoms. All items together reflected the mood, physical discomfort symptoms, spiritual movement, and behavioral and psychological symptoms of patients with depression. The scores were obtained using the scoring method in ascending order (1 to 4) based on the frequency of occurrence of positive symptoms. The scores were obtained using the reverse scoring method in descending order (4 to 1) based on the occurrence frequency of occurrence of negative symptoms. The standard score was obtained by multiplying the scores by 1.25 and rounding the result. A higher score indicated a more significant tendency of depression. The grade description was as follows: 50–59 indicated mild depression, 60–69 indicated medium depression and ≥70 indicated severe depression [13].
The WHOQOL-BREF scale comprised 26 items, including the physiological, psychological, social, and environmental fields. Item 1 and Item 2 are two independent topics, and their total scores were used as an overall index to evaluate quality of life. Each item in the scale is designed to be graded from 1 to 5, corresponding to 1 to 5 points, and Items 3, 4 and 26 are reverse-scored and graded from 1 to 5, corresponding to 5 to 1 points. The higher the score, the higher the parents’ quality of life [14].
Statistical analysis
SPSS 25.0 was used for statistical analysis. Continuous data are presented as mean ± standard deviation and range. The normal distribution test was performed on all continuous data, and the data followed a normal distribution. Clinical parameters between the two groups were compared with the independent samples t-test. The χ2 or Fisher’s test was used to categorize the variables. A P value of <0.05 was defined as significant.
Results
The demographic characteristics of the patients and their parents are shown in Table 1, and there were no statistically significant differences between the two groups. Table 2 shows that the SAS and SDS scores of the parents at the time of discharge between the two groups were similar without a statistically significant difference. These results indicate that the patients and parents in the two groups were homogenous and comparable.
. | Intervention group . | Control group . | P . |
---|---|---|---|
Age (month) | 4.7 ± 4.3 | 4.9 ± 4.4 | 0.469 |
Weight (kg) | 4.6 ± 3.1 | 4.8 ± 3.4 | 0.513 |
Disease | |||
Ventricular septal defect | 25 | 28 | 0.949 |
Patent ductus arteriosus | 7 | 4 | |
Pulmonary stenosis | 5 | 5 | |
Tetralogy of Fallot | 1 | 1 | |
Endocardial cushion defect | 1 | 1 | |
Total anomalous pulmonary venous connect | 1 | 2 | |
Aortic arch interrupt | 2 | 1 | |
Age of parents (year) | 29.1 ± 6.5 | 28.8 ± 7.1 | 0.498 |
Parents’ education level | |||
Under high school | 8 | 7 | 0.968 |
High school | 12 | 14 | |
Junior college | 14 | 13 | |
Bachelor degree or higher | 8 | 8 | |
Living condition | |||
Rural area | 30 | 28 | 0.637 |
City | 12 | 14 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
Age (month) | 4.7 ± 4.3 | 4.9 ± 4.4 | 0.469 |
Weight (kg) | 4.6 ± 3.1 | 4.8 ± 3.4 | 0.513 |
Disease | |||
Ventricular septal defect | 25 | 28 | 0.949 |
Patent ductus arteriosus | 7 | 4 | |
Pulmonary stenosis | 5 | 5 | |
Tetralogy of Fallot | 1 | 1 | |
Endocardial cushion defect | 1 | 1 | |
Total anomalous pulmonary venous connect | 1 | 2 | |
Aortic arch interrupt | 2 | 1 | |
Age of parents (year) | 29.1 ± 6.5 | 28.8 ± 7.1 | 0.498 |
Parents’ education level | |||
Under high school | 8 | 7 | 0.968 |
High school | 12 | 14 | |
Junior college | 14 | 13 | |
Bachelor degree or higher | 8 | 8 | |
Living condition | |||
Rural area | 30 | 28 | 0.637 |
City | 12 | 14 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
Age (month) | 4.7 ± 4.3 | 4.9 ± 4.4 | 0.469 |
Weight (kg) | 4.6 ± 3.1 | 4.8 ± 3.4 | 0.513 |
Disease | |||
Ventricular septal defect | 25 | 28 | 0.949 |
Patent ductus arteriosus | 7 | 4 | |
Pulmonary stenosis | 5 | 5 | |
Tetralogy of Fallot | 1 | 1 | |
Endocardial cushion defect | 1 | 1 | |
Total anomalous pulmonary venous connect | 1 | 2 | |
Aortic arch interrupt | 2 | 1 | |
Age of parents (year) | 29.1 ± 6.5 | 28.8 ± 7.1 | 0.498 |
Parents’ education level | |||
Under high school | 8 | 7 | 0.968 |
High school | 12 | 14 | |
Junior college | 14 | 13 | |
Bachelor degree or higher | 8 | 8 | |
Living condition | |||
Rural area | 30 | 28 | 0.637 |
City | 12 | 14 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
Age (month) | 4.7 ± 4.3 | 4.9 ± 4.4 | 0.469 |
Weight (kg) | 4.6 ± 3.1 | 4.8 ± 3.4 | 0.513 |
Disease | |||
Ventricular septal defect | 25 | 28 | 0.949 |
Patent ductus arteriosus | 7 | 4 | |
Pulmonary stenosis | 5 | 5 | |
Tetralogy of Fallot | 1 | 1 | |
Endocardial cushion defect | 1 | 1 | |
Total anomalous pulmonary venous connect | 1 | 2 | |
Aortic arch interrupt | 2 | 1 | |
Age of parents (year) | 29.1 ± 6.5 | 28.8 ± 7.1 | 0.498 |
Parents’ education level | |||
Under high school | 8 | 7 | 0.968 |
High school | 12 | 14 | |
Junior college | 14 | 13 | |
Bachelor degree or higher | 8 | 8 | |
Living condition | |||
Rural area | 30 | 28 | 0.637 |
City | 12 | 14 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
At the discharge time | |||
Score of SAS | 67.3 ± 14.3 | 66.3 ± 13.8 | 0.663 |
Score of SDS | 64.4 ± 11.6 | 63.8 ± 12.9 | 0.712 |
One month after discharge | |||
Score of SAS | 50.2 ± 8.9a | 62.1 ± 12.2 | 0.028 |
Score of SDS | 48.9 ± 9.2a | 59.8 ± 10.5 | 0.032 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
At the discharge time | |||
Score of SAS | 67.3 ± 14.3 | 66.3 ± 13.8 | 0.663 |
Score of SDS | 64.4 ± 11.6 | 63.8 ± 12.9 | 0.712 |
One month after discharge | |||
Score of SAS | 50.2 ± 8.9a | 62.1 ± 12.2 | 0.028 |
Score of SDS | 48.9 ± 9.2a | 59.8 ± 10.5 | 0.032 |
Showed that compared with the score of each corresponding item at the time of discharge P < 0.05.
. | Intervention group . | Control group . | P . |
---|---|---|---|
At the discharge time | |||
Score of SAS | 67.3 ± 14.3 | 66.3 ± 13.8 | 0.663 |
Score of SDS | 64.4 ± 11.6 | 63.8 ± 12.9 | 0.712 |
One month after discharge | |||
Score of SAS | 50.2 ± 8.9a | 62.1 ± 12.2 | 0.028 |
Score of SDS | 48.9 ± 9.2a | 59.8 ± 10.5 | 0.032 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
At the discharge time | |||
Score of SAS | 67.3 ± 14.3 | 66.3 ± 13.8 | 0.663 |
Score of SDS | 64.4 ± 11.6 | 63.8 ± 12.9 | 0.712 |
One month after discharge | |||
Score of SAS | 50.2 ± 8.9a | 62.1 ± 12.2 | 0.028 |
Score of SDS | 48.9 ± 9.2a | 59.8 ± 10.5 | 0.032 |
Showed that compared with the score of each corresponding item at the time of discharge P < 0.05.
All patients were followed up 1 month after discharge. One month after discharge, the SAS and SDS scores of the parents in the intervention group were significantly lower than those of parents in the control group (P < 0.05). Compared with the SAS and SDS scores at discharge, the scores of parents in the intervention group were significantly lower at 1 month after discharge (P < 0.05), while the scores of the parents in the control group were similar at 1 month after discharge (P > 0.05). (Table 2).
At discharge, in both the intervention group and the control group, the SAS and SDS scores of the mothers were higher than those of the fathers (P < 0.05). One month after discharge, in the control group, the SAS and SDS scores of the mothers were higher than those of the fathers (P < 0.05). One month after discharge, in the intervention group, the SAS and SDS scores of the mothers were similar to those of the fathers (P > 0.05). (Table 3).
. | Intervention group . | P . | Control group . | P . | ||
---|---|---|---|---|---|---|
Father . | Mother . | Father . | Mother . | |||
At the time of discharge | ||||||
Score of SAS | 62.3 ± 13.5 | 73.4 ± 15.2 | 0.028 | 62.8 ± 12.6 | 70.5 ± 14.8 | 0.035 |
Score of SDS | 61.6 ± 10.3 | 69.8 ± 13.7 | 0.030 | 60.7 ± 11.3 | 67.9 ± 14.2 | 0.037 |
One month after discharge | ||||||
Score of SAS | 48.7 ± 7.2 | 52.6 ± 9.4 | 0.254 | 58.3 ± 11.5 | 67.8 ± 13.3 | 0.038 |
Score of SDS | 47.1 ± 8.1 | 50.8 ± 9.7 | 0.376 | 56.8 ± 9.6 | 65.3 ± 12.3 | 0.041 |
. | Intervention group . | P . | Control group . | P . | ||
---|---|---|---|---|---|---|
Father . | Mother . | Father . | Mother . | |||
At the time of discharge | ||||||
Score of SAS | 62.3 ± 13.5 | 73.4 ± 15.2 | 0.028 | 62.8 ± 12.6 | 70.5 ± 14.8 | 0.035 |
Score of SDS | 61.6 ± 10.3 | 69.8 ± 13.7 | 0.030 | 60.7 ± 11.3 | 67.9 ± 14.2 | 0.037 |
One month after discharge | ||||||
Score of SAS | 48.7 ± 7.2 | 52.6 ± 9.4 | 0.254 | 58.3 ± 11.5 | 67.8 ± 13.3 | 0.038 |
Score of SDS | 47.1 ± 8.1 | 50.8 ± 9.7 | 0.376 | 56.8 ± 9.6 | 65.3 ± 12.3 | 0.041 |
. | Intervention group . | P . | Control group . | P . | ||
---|---|---|---|---|---|---|
Father . | Mother . | Father . | Mother . | |||
At the time of discharge | ||||||
Score of SAS | 62.3 ± 13.5 | 73.4 ± 15.2 | 0.028 | 62.8 ± 12.6 | 70.5 ± 14.8 | 0.035 |
Score of SDS | 61.6 ± 10.3 | 69.8 ± 13.7 | 0.030 | 60.7 ± 11.3 | 67.9 ± 14.2 | 0.037 |
One month after discharge | ||||||
Score of SAS | 48.7 ± 7.2 | 52.6 ± 9.4 | 0.254 | 58.3 ± 11.5 | 67.8 ± 13.3 | 0.038 |
Score of SDS | 47.1 ± 8.1 | 50.8 ± 9.7 | 0.376 | 56.8 ± 9.6 | 65.3 ± 12.3 | 0.041 |
. | Intervention group . | P . | Control group . | P . | ||
---|---|---|---|---|---|---|
Father . | Mother . | Father . | Mother . | |||
At the time of discharge | ||||||
Score of SAS | 62.3 ± 13.5 | 73.4 ± 15.2 | 0.028 | 62.8 ± 12.6 | 70.5 ± 14.8 | 0.035 |
Score of SDS | 61.6 ± 10.3 | 69.8 ± 13.7 | 0.030 | 60.7 ± 11.3 | 67.9 ± 14.2 | 0.037 |
One month after discharge | ||||||
Score of SAS | 48.7 ± 7.2 | 52.6 ± 9.4 | 0.254 | 58.3 ± 11.5 | 67.8 ± 13.3 | 0.038 |
Score of SDS | 47.1 ± 8.1 | 50.8 ± 9.7 | 0.376 | 56.8 ± 9.6 | 65.3 ± 12.3 | 0.041 |
The comparison of the SAS and SDS scores of parents with different education levels showed that in both the intervention group and control group, parents with lower educational levels had higher SAS and SDS scores (P < 0.05). One month after discharge, in the control group, the lower the education level of the parents was, the higher the SAS and SDS scores (P < 0.05). One month after discharge, in the intervention group, the SAS and SDS scores were similar among parents with different educational levels (Table 4).
. | Intervention group . | . | Control group . | . | ||||
---|---|---|---|---|---|---|---|---|
. | High school or lower . | Junior college . | Bachelor degree or higher . | P . | High school or lower . | Junior college . | Bachelor degree or higher . | P . |
At the time of discharge | ||||||||
Score of SAS | 74.5 ± 15.4 | 66.2 ± 13.8a | 60.3 ± 12.8ab | 0.021 | 71.6 ± 14.6 | 65.7 ± 13.5a | 59.1 ± 12.5ab | 0.034 |
Score of SDS | 71.3 ± 14.6 | 65.3 ± 13.2a | 58.6 ± 11.3ab | 0.023 | 70.5 ± 13.4 | 62.4 ± 11.6a | 56.4 ± 10.2ab | 0.037 |
One month after discharge | ||||||||
Score of SAS | 53.3 ± 9.3 | 50.8 ± 8.7 | 47.9 ± 7.9 | 0.352 | 68.6 ± 13.7 | 62.4 ± 13.0a | 57.1 ± 11.8ab | 0.039 |
Score of SDS | 51.2 ± 9.8 | 49.2 ± 9.0 | 46.8 ± 8.1 | 0.286 | 67.2 ± 12.8 | 62.0 ± 13.1a | 54.3 ± 11.2ab | 0.040 |
. | Intervention group . | . | Control group . | . | ||||
---|---|---|---|---|---|---|---|---|
. | High school or lower . | Junior college . | Bachelor degree or higher . | P . | High school or lower . | Junior college . | Bachelor degree or higher . | P . |
At the time of discharge | ||||||||
Score of SAS | 74.5 ± 15.4 | 66.2 ± 13.8a | 60.3 ± 12.8ab | 0.021 | 71.6 ± 14.6 | 65.7 ± 13.5a | 59.1 ± 12.5ab | 0.034 |
Score of SDS | 71.3 ± 14.6 | 65.3 ± 13.2a | 58.6 ± 11.3ab | 0.023 | 70.5 ± 13.4 | 62.4 ± 11.6a | 56.4 ± 10.2ab | 0.037 |
One month after discharge | ||||||||
Score of SAS | 53.3 ± 9.3 | 50.8 ± 8.7 | 47.9 ± 7.9 | 0.352 | 68.6 ± 13.7 | 62.4 ± 13.0a | 57.1 ± 11.8ab | 0.039 |
Score of SDS | 51.2 ± 9.8 | 49.2 ± 9.0 | 46.8 ± 8.1 | 0.286 | 67.2 ± 12.8 | 62.0 ± 13.1a | 54.3 ± 11.2ab | 0.040 |
Showed that compared with the score of High school or lower P < 0.05.
Showed that compared with the score of Junior college P < 0.05.
. | Intervention group . | . | Control group . | . | ||||
---|---|---|---|---|---|---|---|---|
. | High school or lower . | Junior college . | Bachelor degree or higher . | P . | High school or lower . | Junior college . | Bachelor degree or higher . | P . |
At the time of discharge | ||||||||
Score of SAS | 74.5 ± 15.4 | 66.2 ± 13.8a | 60.3 ± 12.8ab | 0.021 | 71.6 ± 14.6 | 65.7 ± 13.5a | 59.1 ± 12.5ab | 0.034 |
Score of SDS | 71.3 ± 14.6 | 65.3 ± 13.2a | 58.6 ± 11.3ab | 0.023 | 70.5 ± 13.4 | 62.4 ± 11.6a | 56.4 ± 10.2ab | 0.037 |
One month after discharge | ||||||||
Score of SAS | 53.3 ± 9.3 | 50.8 ± 8.7 | 47.9 ± 7.9 | 0.352 | 68.6 ± 13.7 | 62.4 ± 13.0a | 57.1 ± 11.8ab | 0.039 |
Score of SDS | 51.2 ± 9.8 | 49.2 ± 9.0 | 46.8 ± 8.1 | 0.286 | 67.2 ± 12.8 | 62.0 ± 13.1a | 54.3 ± 11.2ab | 0.040 |
. | Intervention group . | . | Control group . | . | ||||
---|---|---|---|---|---|---|---|---|
. | High school or lower . | Junior college . | Bachelor degree or higher . | P . | High school or lower . | Junior college . | Bachelor degree or higher . | P . |
At the time of discharge | ||||||||
Score of SAS | 74.5 ± 15.4 | 66.2 ± 13.8a | 60.3 ± 12.8ab | 0.021 | 71.6 ± 14.6 | 65.7 ± 13.5a | 59.1 ± 12.5ab | 0.034 |
Score of SDS | 71.3 ± 14.6 | 65.3 ± 13.2a | 58.6 ± 11.3ab | 0.023 | 70.5 ± 13.4 | 62.4 ± 11.6a | 56.4 ± 10.2ab | 0.037 |
One month after discharge | ||||||||
Score of SAS | 53.3 ± 9.3 | 50.8 ± 8.7 | 47.9 ± 7.9 | 0.352 | 68.6 ± 13.7 | 62.4 ± 13.0a | 57.1 ± 11.8ab | 0.039 |
Score of SDS | 51.2 ± 9.8 | 49.2 ± 9.0 | 46.8 ± 8.1 | 0.286 | 67.2 ± 12.8 | 62.0 ± 13.1a | 54.3 ± 11.2ab | 0.040 |
Showed that compared with the score of High school or lower P < 0.05.
Showed that compared with the score of Junior college P < 0.05.
The results of the WHOQOL-BREF scale showed that the scores of the physiological, psychological, social and environmental fields at 1 month after discharge in the intervention group were significantly higher than those in the control group (P < 0.05) (Table 5).
. | Intervention group . | Control group . | P . |
---|---|---|---|
Physiological fields | 15.6 ± 3.1 | 10.8± 3.3 | 0.028 |
Psychological fields | 16.2 ± 2.9 | 10.2 ± 3.5 | 0.017 |
Social fields | 16.5 ± 3.0 | 9.7 ± 3.6 | 0.012 |
Environmental fields | 15.8 ± 2.8 | 9.9 ± 3.1 | 0.026 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
Physiological fields | 15.6 ± 3.1 | 10.8± 3.3 | 0.028 |
Psychological fields | 16.2 ± 2.9 | 10.2 ± 3.5 | 0.017 |
Social fields | 16.5 ± 3.0 | 9.7 ± 3.6 | 0.012 |
Environmental fields | 15.8 ± 2.8 | 9.9 ± 3.1 | 0.026 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
Physiological fields | 15.6 ± 3.1 | 10.8± 3.3 | 0.028 |
Psychological fields | 16.2 ± 2.9 | 10.2 ± 3.5 | 0.017 |
Social fields | 16.5 ± 3.0 | 9.7 ± 3.6 | 0.012 |
Environmental fields | 15.8 ± 2.8 | 9.9 ± 3.1 | 0.026 |
. | Intervention group . | Control group . | P . |
---|---|---|---|
Physiological fields | 15.6 ± 3.1 | 10.8± 3.3 | 0.028 |
Psychological fields | 16.2 ± 2.9 | 10.2 ± 3.5 | 0.017 |
Social fields | 16.5 ± 3.0 | 9.7 ± 3.6 | 0.012 |
Environmental fields | 15.8 ± 2.8 | 9.9 ± 3.1 | 0.026 |
Discussion
Statement of principal findings
Over the past three decades, with advances in surgical techniques and perioperative care, pediatric cardiac surgery has shifted from corrective surgery in childhood to infancy, and the survival rates have been improving [15, 16]. In view of advances in medical treatment and surgery, CHD is rapidly becoming the most common chronic disease in children [17, 18]. With the improvement of people’s living standards, people have increasingly higher requirements for quality of life and pay increasing attention to the enjoyment of life. Currently, quality of life is regarded as an important index to evaluate health and living standards.
Studies have shown that parents of infants with CHD have significantly greater life stress, anxiety and depression and lower quality of life, due to greater investment in emotion, energy and resources, than parents of infants with other diseases and parents of healthy children [19–22]. CHD requiring surgical treatment in infancy is usually more serious, and complications such as cardiac insufficiency, arrhythmia, pulmonary infection and malnutrition are more likely to occur after surgery, which requires a long recovery period. Therefore, infants that undergo CHD surgery need a long period of high-quality care and close follow-up after surgery. Medical services and support for the patients is terminated after discharge in the current medical model, and the parents need to independently care for the patients at home [23]. Due to the lack of knowledge on CHD and home care, parents usually need to do more work night and day to take care of infants at home after CHD surgery so that the parents feel great anxiety and stress, even in a poor mental state, which eventually leads to a lower quality of life [24]. For parents with low education levels that live in rural areas with less access to medical support, the negative emotions and stress are more obvious due to their low autonomous learning abilities and difficulty in seeking medical support. However, studies have mainly focused on improving the prognosis and quality of life of patients, with little attention given to the parents’ quality of life. The purpose of this study was to find a new way to deliver health education to provide the parents of patients with more convenient access to help, reduce the anxiety of home care and improve their quality of life.
Interpretation within the context of the wider literature
Telemedicine has recently been widely used as an educational health promotion strategy for the management of diseases such as diabetes, hypertension, depression and heart disease [6–10]. Practice has proven that telemedicine is more effective than traditional information transmission in terms of shortening time consumption, improving patients’ conditions and improving the quality of life of the patients’ families [25].
WeChat is the most widely used mobile app in China, so we used it as a telemedicine platform to deliver health education for parents of infants with CHD after discharge in this study.
Parents in the intervention group could access the WeChat educational module at any time and from anywhere according to their needs. When the parents had problems, they could consult the medical staff through WeChat anytime and anywhere, and they could obtain timely and effective answers and professional support.
After discharge, the hospital’s high-quality medical services can be extended to the family via WeChat, which can strengthen the relationship between the doctors and parents of infants. It was beneficial for the medical staff to understand the infants’ physical state and help to solve the problem of insufficient medical support by providing parents adequate support in a timely manner, which was the biggest concern of the infants’ parents after surgery and discharge. The use of WeChat greatly relieved pressure of care, anxiety and depression and improved the parents’ quality of life. In this study, the quality of life of the parents in the intervention group was significantly higher than that in the parents in the control group.
Many studies have shown that mothers of infants with CHD had more anxiety and depression than fathers. Due to the different social divisions of labor, mothers are the main caregivers of infants with CHD, and mothers directly face more care difficulties. Similar results were also obtained in this study [26–28]. However, the mental states of the fathers and mothers in the intervention group were similar 1 month after discharge. The reason for this was considered as follows: continuous medical support for the family via WeChat could effectively solve the difficulties of care for the mother (as the primary caregiver) and greatly alleviate her poor mental state. This study also showed that the higher the educational level of parents, the lower the levels of anxiety and depression because the more educated the parents were, the more likely they were to learn home care skills during a brief hospital stay, and to seek medical support. One month after discharge, in the intervention group, the degree of anxiety and depression were similar among parents with different educational levels, which indicated that continuous medical support for families through WeChat could obviously improve the ability of caring of parents with low education levels and reduce their psychological burdens.
Strengths and limitations
This paper has some limitations. First, some patients could not be recruited due to poor internet support, especially in rural areas of China. Second, it was a single-center study. Third, the follow-up time was short.
Implications for policy, practice and research
Telehealth education via WeChat is convenient, economical and continuous, and it can effectively extend the high-quality medical services of the hospital to families, which can provide great help to the parents of patients.
Conclusion
Delivering health education and home care guidance via telemedicine using WeChat can effectively extend the high-quality medical services of the hospital to the families of infants with CHD, which can effectively relieve the anxiety and depression of the parents and improve their quality of life.
Acknowledgements
We thank all doctors in our center for their fruitful advice and discussions.
Funding
None declared.
Data availability
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Contributions
Z.Q.L., C.Q. and C.H. designed the study, collected the clinical data, performed the data analysis, drafted the manuscript and revised the article. L.J.F. and L.Y.Q. collected the clinical data and drafted the manuscript. All authors read and approved the final manuscript.
Ethics and other permissions
This study was approved by the ethics committee of our hospital and strictly adhered to the tenets of the Declaration of Helsinki. In addition, all patients’ guardians signed an informed consent form before the study.