EFFICACY OF A NURSE-FACILITATED TELEHEALTH MINDFULNESS INTERVENTION FOR CHRONIC DISEASE SELF-MANAGEMENT IN RURAL HEART FAILURE PATIENTS.

Background: Chronic heart failure is a prevalent condition associated with high symptom burden, frequent hospitalizations, and reduced self-management confidence, particularly among patients residing in rural regions with limited access to specialized care. Behavioral and psychosocial interventions, including mindfulness-based strategies, have shown potential to enhance patient self-efficacy and improve clinical outcomes. However, evidence regarding the integration of nurse-facilitated telehealth mindfulness interventions in rural heart failure populations remains limited. Objective: This study aimed to evaluate the impact of a nurse-facilitated telehealth mindfulness program on self-efficacy, symptom burden, and unplanned hospital admissions in rural patients living with chronic heart failure. Methods: A five-month randomized controlled trial was conducted in Southern Punjab involving 80 adult patients diagnosed with chronic heart failure. Participants were randomly allocated to either an intervention group receiving weekly telehealth mindfulness sessions facilitated by trained nurses alongside standard care, or a control group receiving usual care alone. Self-efficacy was assessed using the Self-Care of Heart Failure Index (SCHFI), symptom burden using the Kansas City Cardiomyopathy Questionnaire (KCCQ), and unplanned hospital admissions were tracked via medical records and follow-up interviews. Data were analyzed using independent and paired t-tests for continuous variables and chi-square tests for categorical outcomes. Results: Post-intervention, the intervention group demonstrated significant improvements in self-efficacy (mean SCHFI 64.3 ± 8.5 vs 51.2 ± 9.0 in controls, p=0.001) and reduced symptom burden (mean KCCQ 71.5 ± 8.7 vs 60.2 ± 9.5, p=0.002). Unplanned hospital admissions were lower in the intervention group (18.4%) compared with controls (39.5%, p=0.042). A moderate negative correlation was observed between self-efficacy and symptom burden (r = −0.52, p<0.01). Conclusion: The nurse-facilitated telehealth mindfulness intervention effectively enhanced self-management confidence, reduced symptom burden, and decreased unplanned hospitalizations among rural heart failure patients. These findings support the integration of structured behavioral and psychosocial strategies into telehealth programs to improve patient-centered outcomes in underserved populations. Keywords: Chronic disease, Heart failure, Mindfulness, Rural health, Self-efficacy, Symptom management, Telehealth