Abstract
This study examined mechanisms by which social cognitive theory (SCT) interventions influence health outcomes and the importance of involving partners in recovery following the patients' receipt of an initial implantable cardioverter defibrillator (ICD). We compared direct and indirect intervention effects on patient health outcomes with data from a randomized clinical trial involving two telephone-based interventions delivered during the first 3 months post-ICD implant by experienced trained nurses: P-only conducted only with patients, and P + P conducted with patients and their intimate partners. Each intervention included the patient-focused component. P + P also included a partner-focused intervention component. ICD-specific SCT-derived mediators included self-efficacy expectations, outcome expectations, self-management behavior, and ICD knowledge. Outcomes were assessed at discharge, 3- and 12-months post ICD implant. Patients (N = 301) were primarily Caucasian, male, 64 (± 11.9) years of age with a mean ejection fraction of 34.08 (± 14.3). Intervention effects, mediated through ICD-specific self-efficacy and outcome expectations, were stronger for P + P compared to P-only for physical function (β = 0.04, p = 0.04; β = 0.02, p = 0.04, respectively) and for psychological adjustment (β = 0.06, p = 0.04; β = 0.03, p = 0.04, respectively). SCT interventions show promise for improving ICD patient physical and psychological health outcomes through self-efficacy and outcome expectations. Including partners in post-ICD interventions may potentiate positive outcomes for patients.
Trial registration number (TRN): NCT01252615 (Registration date: 12/02/2010)
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Funding
This study was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health R01HL086580, awarded to Dr. Cynthia Dougherty, PI. Graduate study support was provided by CNPq Science Without Borders (Brazil) and UW School of Nursing Hester McLaws Nursing Scholarship, awarded to Dr. Ana C. S. Liberato.
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All authors contributed to the conception and design of the present study. RCT data used in the analysis was provided by CMD. Data analysis was performed by ACSL and EAT, and reviewed by CMD. The first draft of the manuscript was written by ACLS. All authors contributed to writing and editing subsequent versions of the manuscript. All authors read and approved the final manuscript.
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All study procedures were conducted in accordance with the ethical standards set forth in the 1964 Helsinki declaration and its later amendments and were approved by the University of Washington Institutional Review Board. The present study required the use of existing, de-identified data.
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Liberato, A.C.S., Thompson, E.A. & Dougherty, C.M. Intervention mediating effects of self-efficacy on patient physical and psychological health following ICD implantation. J Behav Med 44, 842–852 (2021). https://doi.org/10.1007/s10865-021-00244-8
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DOI: https://doi.org/10.1007/s10865-021-00244-8