A longitudinal comparative analysis of sustained benefit of a self-care intervention for caregivers of adults with heart failure.

backgroundCaregiving is stressful, and caregivers commonly neglect taking care of themselves. We tested the effectiveness of a virtual health coaching intervention focused on promoting self-care and demonstrated, at 6 months, that self-care, stress, and mental health-related quality of life (HRQL) improved significantly more in caregivers in the intervention group compared to the control group. The objective was to determine if the benefits of health coaching on self-care, stress, and HRQL were sustained at 12 months in caregivers of adults with chronic heart failure.

methodsThis was a secondary analysis of data from a prior randomized controlled trial. Informal caregivers (N = 250) were randomly assigned to an intervention group receiving virtual health coaching and web-based health information or a control group receiving only web-based health information. Caregivers in the 6-month intervention received ≤ 10 sessions of individual synchronous virtual health coaching promoting self-care. The primary outcome, self-care, was measured with the Self-Care Inventory. Secondary outcomes were stress (Perceived Stress Scale) and mental and physical HRQL measured with the SF-36. In this longitudinal comparative analysis of sustained effects, linear mixed effects models were used to estimate differences between groups in change from baseline to 12 months and from 6 to 12 months, the post-intervention interval. Change in the intervention group from 6 to 12 months was also analyzed. Statistically significant effect sizes are reported as estimated mean differences and 95% confidence intervals.

resultsComparing the change in self-care between groups, we found no significant intervention effect from baseline to 12 months (p = 0.28) nor from 6 to 12 months (p = 0.08). Self-care did not change significantly within the intervention group from 6 to 12 months (p = 0.13). Compared to the control group, the intervention group had a significantly greater mean decrease in stress from baseline to 12 months (M=-2.64, 95% CI [-4.82, -0.46], p = 0.02), though not from 6 to 12 months (p = 0.11). Stress did not change significantly within the intervention group from 6 to 12 months (p = 0.45). We found no significant difference in the change in physical HRQL between groups from baseline to 12 months (p = 0.43 nor from 6 to 12 months (p = 0.052). However, physical HRQL increased significantly in the intervention group from 6 to 12 months (M = 1.44, 95% CI [0.02, 2.85], p = 0.047). Mental HRQL improvement did not differ significantly between treatment and control groups from baseline to 12 months (p = 0.64) nor from 6 to 12 months (p = 0.08). Mental HRQL did not improve significantly in the intervention group from 6 to 12 months (p = 0.37).

conclusionsIn informal caregivers of adults with heart failure, virtual health coaching led to sustained benefits in stress and physical HRQL, even 6 months after health coaching ended. Sustained benefit was not seen in self-care or mental HRQL.

trial registrationRegistered in ClinicalTrials.gov (NCT03988621) on October 23, 2019.