Health Coaching Improves Outcomes of Informal Caregivers of Adults With Chronic Heart Failure: A Randomized Controlled Trial
Bárbara Riegel, Ryan Quinn, Karen B. Hirschman, Gladys Thomas, Rebecca L. Ashare, Michael A. Stawnychy, Kathryn H. Bowles, Subhash Aryal, Joyce Wald
Abstract
BACKGROUND: Caring for someone with heart failure takes an emotional and physical toll. Engaging in self-care may decrease stress and improve the health of informal caregivers. We conducted a randomized controlled trial testing the efficacy of a virtual health coaching intervention, compared with health information alone, on the self-care, stress, coping, and health status of heart failure caregivers. METHODS: We enrolled 250 caregivers providing care at least 8 hours/week, reporting poor self-care, and able to use technology. All received a tablet device programmed with websites providing vetted information on heart failure and caregiving. Half were randomized to also receive 10 synchronous support sessions virtually with a health coach over 6 months. Data on self-care, stress, coping, and health status were collected at baseline and 3 and 6 months. Linear mixed-effects models were used to assess the interaction between time and treatment group. RESULTS: The sample was majority female (85.2%), White (62.2%), spouses (59.8%), and aged 55±13.6 years. Many were employed full time (41.8%). They had been caring for the patient 8 hours/day for a median of 3.25 years. In the intention-to-treat analysis, caregivers who received the health coach intervention had statistically and clinically greater improvement across 6 months compared with the control group in the primary outcome of self-care maintenance (5.05±1.99; P =0.01) and stress (−4.50±1.00; P <0.0001). Self-care neglect declined significantly (−0.65±0.32; P =0.04), but the difference between the treatment arms disappeared when the results were adjusted for multiple comparisons. Mental health status improved statistically but not clinically (3.35±1.61; P =0.04). Active coping improved in both groups but not significantly more in the intervention group ( P =0.10). Physical health status was unchanged ( P =0.27). CONCLUSIONS: This virtual health coaching intervention was effective in improving self-care and stress in heart failure caregivers.