JMIR Publications

ABSTRACT

Background:

Heart failure (HF) remains a disease of notable disparity for rural Veterans, despite recent advancements in clinical treatment. Managing HF in the home is stressful and complex for rural Veterans who experience unique barriers to health maintenance and optimal physical and mental health, necessitating adequate support and problem-solving skills.

Objective:

The aims of this study are two-fold: 1) adapt the CARE-HF intervention to the rural sociocultural context using findings from preliminary qualitative research and 2) evaluate the effects of a culturally sensitive, tailored, telephone-based support and problem-solving intervention (CARE-HF) on problem-solving and physical and mental health outcomes among rural Veterans living with HF.

Methods:

A repeated-measures, single-group design will be used. The adapted intervention will be guided by the Theories of Social Problem-Solving and Stress, Appraisal, and Coping. Veterans with HF (n = 100) will receive the CARE-HF intervention. The nurse-led intervention consists of 8 telephone-based sessions which utilize a five-step problem-solving process to manage common HF problems in the home. The five steps include 1) identifying the problem and viewing it in a positive manner, 2) goal setting, 3) generating potential strategies for problem management, 4) choosing and implementing strategies to manage the problem, and 5) evaluating strategy effectiveness. Veterans will receive initial problem-solving training during the first session, with follow-up sessions focusing on problem-solving skill reinforcement and assisting Veterans in applying these principles to manage self-identified HF-related problems experienced in the home. Data will be collected at baseline and 3-, 6-, 12-, and 18-months post-baseline on problem-solving and outcomes of interest (i.e., HF self-care, HF symptoms, healthcare utilization, depressive symptoms, anxiety, HF-specific HRQOL, stress, resilience, and coping). Data will be analyzed using descriptive statistics and Growth Curve Modeling.

Results:

We anticipate that our intervention will improve problem-solving, HF self-care, HRQOL, resilience, and coping, and decrease HF symptoms, healthcare utilization, depressive symptoms, anxiety, and stress across all time points from baseline.

Conclusions:

Adapting and testing a culturally sensitive, tailored, telephone-based intervention to aid support and problem-solving in the home has the potential to provide individualized care to rural Veterans where they reside, thereby reducing travel burden while also increasing access to evidence-based care programs. If effective, telephone-based support and problem-solving interventions could be a low-cost, accessible method to improve physical and mental health in rural Veterans with HF. Clinical Trial: Supporting Health in Veterans with Heart Failure (CARE-HF). Protocol ID: 00003764; Registered at ClinicalTrials.gov (NCT05839067)