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Intervention mediating effects of self-efficacy on patient physical and psychological health following ICD implantation

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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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Contributions

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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Correspondence to Cynthia M. Dougherty.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in 38 this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

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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Consent Written informed consent was obtained from all individual participants included in the study. Study participants consented to the publication of data reported in group format, without personal identifiers.

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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

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