Predictors of completion and response to a psychological intervention to promote health behavior adherence in heart failure

Abstract

Objective Most individuals with heart failure (HF) struggle to adhere to one or more health behaviors, and interventions to promote adherence are time-intensive and costly. In this analysis, we examined the predictors of engagement and response related to a telephone-delivered health behavior intervention for individuals with HF. Method Using data from two pilot trials (N = 25) of a behavioral intervention for individuals with New York Heart Association (NYHA) class I-II HF, we examined predictors of intervention engagement and response using linear and mixed effects regression analyses. Predictors included medical (NYHA class, physical health-related quality of life [HRQoL], and HF symptoms) and intervention (ease and usefulness/utility ratings of the first intervention exercise) characteristics. Outcomes included percentage of sessions completed, accelerometer-measured physical activity, and sodium intake. Results Lower physical HRQoL and more frequent HF symptoms were associated with completion of more sessions. In contrast, more frequent HF symptoms and higher NYHA class were associated with less physical activity improvement. Finally, participants’ ratings of the first session’s utility were associated with greater improvements in physical activity at follow-up. Conclusions These findings suggest that while individuals with greater functional impairment are more engaged in a behavioral intervention, they may be less able to increase physical activity in response to the program. Furthermore, the perceived utility of an initial session may predict longer-term behavior change. Larger studies are needed to clarify the presence of additional predictors and determine how they can be used to better tailor health behavior interventions.

Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial

“…Other sociodemographic variables such as higher levels of formal education, income, and socioeconomic status have been linked to higher health-behavior adherence in chronic conditions [3,23,24]. Regarding medical factors, individuals with more HF symptoms and those with certain comorbidities (e.g., pulmonary, renal disease) appear to be more likely to engage in self-care activities or interventions to improve self-care [3,25,26]. Finally, the relationships between self-care and health-related quality of life (HRQoL) in patients with HF is mixed, with some studies finding that self-care interventions improve HRQoL and others finding no effects of self-care interventions on HRQoL [27].…”