Health coaching to improve self-care of informal caregivers of adults with chronic heart failure - iCare4Me: Study protocol for a randomized controlled trial

Abstract

Background: Persons with chronic heart failure are living longer. These patients typically live in the community and are cared for at home by informal caregivers. These caregivers are an understudied and stressed group.

Methods: We are conducting a two-arm, randomized controlled trial of 250 caregivers of persons with chronic heart failure to evaluate the efficacy of a health coaching intervention. A consecutive sample of participants is being enrolled from both clinic and hospital settings at a single institution affiliated with a large medical center in the northeastern US. Both the intervention and control groups receive tablets programmed to provide standardized health information. In addition, the intervention group receives 10 live coaching sessions delivered virtually by health coaches using the tablets. The intervention is evaluated at 6-months, with self-care as the primary outcome. Cost-effectiveness of the intervention is evaluated at 12-months. We are also enrolling heart failure patients (dyads) whenever possible to explore the effect of caregiver outcomes (self-care, stress, coping, health status) on heart failure patient outcomes (number of hospitalizations and days in the hospital) at 12-months.

Discussion: We expect the proposed study to require 5 years for completion. If shown to be efficacious and cost-effective, our virtual health coaching intervention can easily be scaled to. support millions of caregivers worldwide.

Keywords: Caregivers; Health coaching; Heart failure; Psychological stress; Psychosocial support systems; Self-care; Telehealth.

Figure 1.

Transactional Model of Stress and Coping. Caregiving demand is a stressor that initiates a process of primary appraisal (e.g., perceived burden) and secondary appraisal (e.g. controllability) in caregivers. These appraisals lead to coping efforts, which are supported with our ViCCY (Virtual Caregiver Coach for You) intervention. ViCCY is anticipate to promote caregiver coping and improve self-care (e.g., eat better, sleep more, exercise), which will improve caregiver health status. An intervention that improves caregiver outcomes may improve heart failure patient outcomes, but patient outcomes are not shown here.

Figure 2.

Graphic illustration of the front-loaded sessions with the health coach. Early sessions occur weekly and decrease in frequency over time. All sessions end within 6 months.

Figure 3.

Schedule of enrollment, interventions, and main assessments, which occur every 3 months