Health Coaching Improves Outcomes of Informal Caregivers of Adults With Chronic Heart Failure: A Randomized Controlled Trial

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.

Keywords: caregivers; coping skills; heart failure; psychological; psychosocial support systems; self-care; self-management; stress.

Figure 1.

CONSORT (Consolidated Standards of Reporting Trials) diagram. The analytic sample size is shown in Table 4. Note that 8 of 125 (6%) caregivers withdrew from the virtual caregiver coach for you (ViCCY) intervention but stayed in the study.

Figure 2.

Changes in self-care over time and by group. A, Change in the self-care inventory maintenance scale (standardized), over time and by group. B, Change in the health self-care neglect scale over time and by group.