Self-Management in Heart Failure: M-Health Interventions, PI: Myra Schmaderer
Specific Aims. The objective of this research is to promote self-management (SM) in a chronic heart failure (HF) population to improve adherence to treatment. Patients with HF are frequently readmitted to the hospital, with one-quarter of readmissions potentially preventable. Numerous studies suggest that a lack of adherence to recommended treatment results in poor patient outcomes such as increased hospitalization, morbidity, and mortality. Improving outcomes for HF patients require adherence to medication and diet and self-monitoring of symptoms. However, despite advances in medical therapy, poor adherence remains a significant problem in this population. Underlying factors associated with non-adherence to treatment regimens (e.g., medication side effects, complex protocols, cognition problems) warrant innovative strategies to support patients’ SM of their chronic illness. Care transition programs have attempted to fill this gap; however, the high incidence of preventable HF readmissions suggests that these programs need further refinement to promote treatment adherence and SM strategies. We propose combining evidence-based SM strategies along with a care transition model delivered by a Nurse Practitioner (NP)/Community Health Worker (CHW) team,7 using mobile technology for access and conferencing as an approach to improve adherence and other patient outcomes (e.g., health related quality of life, patient–reported health status and symptom status).
Although evidence-based guidelines for HF management are available, a gap remains in understanding what strategies promote patient success in adhering to treatment regimens. To address this challenge, we propose an 8-week SM intervention using tailored SM strategies (action planning, goal setting, and individual identified support needs), mobile health (m-Health) technology for real time virtual visits, daily messages and self-monitoring activities. Furthermore, we will test the additive impact of having the NP/CHW team with the m-health platform (m-Health Plus). We will randomly assign 75 patients (25/group) to either Standard Care (SC), m-Health, or m-Health Plus, using a RCT design with repeated measures at 1, 2 and 3 months. The underlying mechanisms of the interventions are to engage HF patients in SM behaviors and HF treatment adherence recommendations by promoting knowledge, self-efficacy, self-management skills, and patient activation.
Aim 1. To evaluate the feasibility of the m-Health and the m-Health Plus intervention by assessing: a) acceptability of the m-Health and m-health Plus; b) enrollment (recruitment efficiency, attrition, problems and solutions), c) intervention fidelity (delivery, receipt, enactment of intervention [benefits and barriers]), and d) data collection (technology transfer of data, instruments reliability, time required, missing data).
Aim 2. To examine the impact of delivering the m-Health and the m-Health Plus intervention by comparing SC in HF patients on the following outcomes: Primary outcome: adherence to lifestyle behaviors (diet and medication, and self-monitoring of weight); Secondary outcomes: health related quality of life (HRQoL); patient–reported health status (PROMIS-29); symptom status (Heart Failure Symptom Survey); and healthcare utilization (HCU) at 1, 2, and 3 months.
Aim 3. To compare the intervention components (knowledge, self-efficacy, SM skills, and patient activation) by group (SC, m-Health and m-Health Plus) at baseline, 1 and 2 months.