The effect of progressive, reinforcing telephone education and counseling versus brief educational intervention on knowledge, self-care behaviors and heart failure symptoms

Abstract

Background: The optimal strategy for promoting self-care for heart failure (HF) is unclear.

Methods and results: We conducted a randomized trial to determine whether a "teach to goal" (TTG) educational and behavioral support program provided incremental benefits to a brief (1 hour) educational intervention (BEI) for knowledge, self-care behaviors, and HF-related quality of life (HFQOL). The TTG program taught use of adjusted-dose diuretics and then reinforced learning goals and behaviors with 5 to 8 telephone counseling sessions over 1 month. Participants' (n = 605) mean age was 61 years; 37% had marginal or inadequate literacy; 69% had ejection fraction <0.45; and 31% had Class III or IV symptoms. The TTG group had greater improvements in general and salt knowledge (P < .001) and greater increases in self-care behaviors (from mean 4.8 to 7.6 for TTG vs. 5.2 to 6.7 for BEI; P < .001). HFQOL improved from 58.5 to 64.6 for the TTG group but did not change for the BEI group (64.7 to 63.9; P < .001 for the difference in change scores). Improvements were similar regardless of participants' literacy level.

Conclusions: Telephone reinforcement of learning goals and self-care behaviors improved knowledge, health behaviors, and HF-related QOL compared to a single education session.

Trial registration: ClinicalTrials.gov NCT00378950.

Copyright © 2011 Elsevier Inc. All rights reserved.

Figures

Figure 1

CONSORT Diagram Showing Participant Study Flow *Some sites were able to identify potentially eligible patients using administrative and electronic health records. Not all patients were approached.

Figure 2

Mean Self-Care Scores (95% CI) at Baseline (●) and One-Month Follow-Up (■) for the Brief Educational Intervention (BEI) and the Teach to Goal (TTG) Groups, Stratified by Health Literacy Level (Adequate and Marginal/Inadequate). CI indicates confidence intervals

Figure 3

Mean Heart Failure Symptom Score (95% CI) at Baseline (●) and One-Month Follow-Up (■) for the Brief Educational Intervention (BEI) and the Teach to Goal (TTG) Groups, Stratified by Health Literacy Level (Adequate and Marginal/Inadequate). CI indicates confidence intervals