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A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure: A Proof-of-Concept Trial.

ABSTRACT: Patients with heart failure (HF) frequently struggle to adhere to health behaviors, and psychological factors may contribute to nonadherence. We examined the feasibility and acceptability of a 10-week, positive psychology (PP)-based intervention to promote health behavior adherence in patients (N = 10) with mild to moderate HF and suboptimal health behavior adherence. Participants engaged in weekly phone sessions, completed PP exercises (e.g., writing a gratitude letter, using a personal strength), and set goals related to diet, medication adherence, and physical activity. Feasibility was assessed by the number of sessions completed, and acceptability by participant ratings of ease and utility. Preliminary efficacy was measured by changes in psychological and adherence outcomes. The intervention was feasible (87% of exercises completed) and acceptable. Furthermore, in exploratory analyses, the intervention was associated with improvements in psychological and health behavior adherence outcomes. Larger, randomized trials are needed to further investigate the utility of this intervention. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02938052.

SUBMITTER: Celano CM

PROVIDER: S-EPMC6169996 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure: A Proof-of-Concept Trial.

Celano Christopher M CM Freedman Melanie E ME Beale Eleanor E EE Gomez-Bernal Federico F Huffman Jeff C JC

The Journal of nervous and mental disease 20181001 10

Patients with heart failure (HF) frequently struggle to adhere to health behaviors, and psychological factors may contribute to nonadherence. We examined the feasibility and acceptability of a 10-week, positive psychology (PP)-based intervention to promote health behavior adherence in patients (N = 10) with mild to moderate HF and suboptimal health behavior adherence. Participants engaged in weekly phone sessions, completed PP exercises (e.g., writing a gratitude letter, using a personal strengt ...[more]

PMID: 30273277

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Project description:OBJECTIVE:Despite the clear benefits of physical activity and related behaviors on prognosis, most patients experiencing an acute coronary syndrome (ACS) remain nonadherent to these behaviors. Deficits in positive psychological constructs (e.g., optimism) are linked to reduced participation in health behaviors, supporting the potential utility of a positive psychology (PP)-based intervention in post-ACS patients. Accordingly, we aimed to identify optimal components of a PP-based intervention to promote post-ACS physical activity. METHODS:As part of a multiphase optimization strategy, we completed a randomized factorial trial with eight conditions in 128 post-ACS patients to efficiently identify best-performing intervention components. All participants received a PP-based intervention, with conditions varying in duration (presence/absence of booster sessions), intensity (weekly/daily PP exercises), and content (PP alone or combined with motivational interviewing), allowing three concurrent comparisons within the trial. The study aims included assessments of the overall feasibility, acceptability, and impact of the intervention, along with the primary aim of determining which components were associated with objectively measured physical activity and self-reported health behavior adherence at 16 weeks, assessed using longitudinal models. RESULTS:The intervention was well accepted and associated with substantial improvements in behavioral and psychological outcomes. Booster sessions were associated with greater activity to a nearly significant degree (? = 8.58, 95% confidence interval = -0.49-17.65, effect size difference = .43, p = .064), motivational interviewing was associated with overall adherence (? = 0.95, 95% confidence interval = 0.02-1.87, effect size difference = .39, p = .044), and weekly exercise completion was generally superior to daily. CONCLUSIONS:These findings will enable optimization of the PP-based intervention in preparation for a well-powered controlled trial. CLINICAL TRIAL REGISTRATION:Clinicaltrials.gov, NCT02754895.

Project description:Smoking and physical inactivity contribute to disproportionate disease burden among underserved adults. Telephone-based interventions (quitlines) are becoming the standard care for addressing smoking. There is increasing interest to determine whether quitlines can be utilized to administer interventions for other unhealthy behaviors. This study aims to examine the proof-of-concept and potential efficacy of a telephone-based behavioral counseling intervention to boost daily low-to-moderate physical activity among low-income, physically inactive smokers. Participants (N = 101) were randomized to receive 4 weeks of counseling prior to their smoking quit day that included either standard smoking cessation counseling (control) or the Step-up to Quit (SUTQ) intervention. SUTQ promoted daily walking to foster physical activity as a primary smoking urge management strategy and facilitate incremental increases in daily steps with the goal of achieving 7500 steps/day by the quit day in week 4. Exploratory structural equation modeling tested SUTQ effects on six measures of low-to-moderate physical activity (primary outcome) and smoking cue reactivity (secondary outcome) simultaneously in a single multivariate model with controlling variables. The sample was 51 % female and 77 % African-American, with a mean age of 42.1 years (SD = 10.9). Compared to the control condition, SUTQ intervention was associated with greater physical activity at week 4 (b = 0.51, z = 1.71, p = 0.08), with between-group differences sustained at follow-up. At week 4, the SUTQ group had higher 7-day mean steps/day (M = 7,207.25, SD = 4,276.03) than controls (M = 3,947.03, SD = 3,655.03) (t = 3.35; p < .01); and had more participants reach the >7500 steps/day goal (49% vs. 11 %, c2 = 10.78; p < .01), a difference that was sustained at 1-month follow-up (X2 = 9.04, p < .01) Effects of SUTQ treatment on cue reactivity were in the hypothesized direction but not significant (b = -0.29; z = -1.09, p = 0.27). To our knowledge, this is the first study to promote physical activity using telephone counseling in an underserved population of smokers known to have greater challenges with physical activity adoption and smoking cessation. The SUTQ approach suggests that integration of physical activity advice and support within the context of smoking cessation treatment has the potential to promote physical activity among smokers intending to quit.

Dataset Information

A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure: A Proof-of-Concept Trial.

Publications

A Positive Psychology Intervention to Promote Health Behaviors in Heart Failure: A Proof-of-Concept Trial.

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