Abstract 11431: The Effect of Progressive, Reinforcing Telephone Education and Counseling versus Brief Educational Intervention on Knowledge, Self-Care Behaviors and Heart Failure Symptoms
Objectives: We conducted a randomized trial to determine whether a “teach to goal” (TTG) educational and behavioral support program was more successful than a brief educational intervention (BEI) for achieving learning goals, promoting self-care behaviors, and improving heart failure (HF) symptoms.
Methods: We recruited patients from 4 academic medical centers who had symptomatic HF (NYHA class II–IV). All received a face to face one hour educational session with a focused curriculum of only the most important learning objectives for promoting self-management behaviors. Patients were then randomized to no further intervention or the TTG program, which immediately taught adjusted-dose diuretics to maintain a target weight and reinforced learning goals and behaviors with 5–8 telephone counseling sessions over the next month. A blinded interviewer assessed knowledge, self-efficacy, behaviors, and the HF Symptom Scale (HFSS; range 0–100, with higher scores denoting fewer symptoms) at baseline and one month.
Results: Of 605 participants, 526 (86.9%) completed the one month telephone interview. The mean age was 61 years; 48% were female; 38% were African-American and 16% Latino; 26% had less than a high school education; 69% had ejection fraction < 0.45; 31% were NYHA class III or IV. After one month, general knowledge and knowledge about high salt foods improved more in the TTG group than the BEI group (p ≤ 0.002 for both). Patients in the TTG group also reported substantially greater increases in the composite index of 10 self-care items than the BEI group (increase from mean of 4.8 to 7.6 for TTG vs. increase from 5.2 to 6.7 for BEI; p<0.001), including awareness of their ideal weight, checking weight daily, self-adjusting diuretic dose to maintain target weight, and having an action plan for a weight gain of ≥ 4 lbs. The HFSS improved from 58.5 to 64.6 for the TTG group but did not change for the BEI group (64.7 to 63.9; p < 0.001 for the difference in change scores).
Conclusions: The TTG strategy of a progressive educational and self-management support program improved knowledge, health behaviors, and HF symptoms compared to a BEI. Longer follow-up is needed to determine whether these differences are sustained and whether the TTG strategy decreased hospitalizations.
- © 2010 by American Heart Association, Inc.