Mechanisms of Change in a Carepartner Mobile Health Intervention for Veterans With Heart Failure
Year: 2017
Type: conference-abstract
Abstract: Heart failure (HF) interventions have recognized that involving an informal caregiver in disease management can enhance outcomes. While patient-focused interventions appear to improve self-efficacy, the mechanisms that underlie dyadic interventions remain largely unexplored. We used data from a recently completed comparative effectiveness trial which examined whether involving a non-cohabitating caregiver (CarePartner) in a mobile health (mHealth) intervention benefited HF outcomes more than mHealth alone did. The mhealth intervention involved weekly interactive voice response (IVR) phone calls to monitor symptoms. In the mHealth+CarePartner arm, participants’ CarePartners received a summary of the participant’s IVR responses. Results of the trial indicated that medication adherence improved significantly more in the mHealth+CarePartner condition. For this secondary analysis, we used serial mediation models to evaluate indirect pathways that might explain this effect. Specifically, we tested whether improvements in patient-reported relationship quality and self-efficacy mediated the effect of intervention upon medication adherence. Relationship quality was measured by frequency of talking with the CarePartner, perceived difficulty of talking with the CarePartner, and negative emotions associated with talking to the CarePartner. Indirect effects were estimated using bias-corrected bootstrapping with 95%CI, which showed a negative association between the intervention arm and self-efficacy. Paired t-tests showed that the mHealth arm was associated with improvements in self-efficacy (t=-4.27, p<.01) while the mHealth+CarePartner arm demonstrated no change (t =-1.59, p = 0.12). Findings suggest that constructs that explain the success of patient-focused self-management strategies, such as self-efficacy, are unlikely to sufficiently explain the success of dyadic interventions in HF.
Source: Innovation in Aging
Authors: R. Trivedi, S. Scott, E. Bouldin, J.E. Aikens, J. Piette
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,977
OpenAlex ID: W2729727971