Meeker Daniella, Goldberg Jordan, Kim Katherine K, Peneva Desi, Campos Hugo De Oliveira, Maclean Ross, Selby Van, Doctor Jason N
Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States.
stickK.com, New York City, NY, United States.
J Med Internet Res. 2019 Aug 6;21(8):e12483. doi: 10.2196/12483.
Over 6 million Americans have heart failure, and 1 in 8 deaths included heart failure as a contributing cause in 2016. Lifestyle changes and adherence to diet and exercise regimens are important in limiting disease progression. Health coaching and public commitment are two interactive communication strategies that may improve self-management of heart failure.
This study aimed to conduct patient focus groups to gain insight into how best to implement health coaching and public commitment strategies within the heart failure population.
Focus groups were conducted in two locations. We studied 2 patients in Oakland, California, and 5 patients in Los Angeles, California. Patients were referred by local cardiologists and had to have a diagnosis of chronic heart failure. We used a semistructured interview tool to explore several patient-centered themes including medication adherence, exercise habits, dietary habits, goals, accountability, and rewards. We coded focus group data using the a priori coding criteria for these domains.
Medication adherence barriers included regimen complexity, forgetfulness, and difficulty coping with side effects. Participants reported that they receive little instruction from care providers on appropriate exercise and dietary habits. They also reported personal and social obstacles to achieving these objectives. Participants were in favor of structured goal setting, use of online social networks, and financial rewards as a means of promoting health lifestyles. Peers were viewed as better motivating agents than family members.
An active communication framework involving dissemination of diet- and exercise-related health information, structured goal setting, peer accountability, and financial rewards appears promising in the management of heart failure.
超过600万美国人患有心力衰竭，2016年每8例死亡中就有1例的死因与心力衰竭有关。改变生活方式以及坚持饮食和运动方案对于限制疾病进展至关重要。健康指导和公众承诺是两种可能改善心力衰竭自我管理的互动沟通策略。
本研究旨在开展患者焦点小组，以深入了解如何在心力衰竭人群中最佳地实施健康指导和公众承诺策略。
在两个地点开展焦点小组。我们研究了加利福尼亚州奥克兰的2名患者和加利福尼亚州洛杉矶的5名患者。患者由当地心脏病专家转诊，且必须被诊断为慢性心力衰竭。我们使用半结构化访谈工具来探讨几个以患者为中心的主题，包括药物依从性、运动习惯、饮食习惯、目标、责任追究和奖励。我们使用这些领域的先验编码标准对焦点小组数据进行编码。
药物依从性障碍包括治疗方案复杂、健忘以及应对副作用困难。参与者报告称，他们从医护人员那里得到的关于适当运动和饮食习惯的指导很少。他们还报告了实现这些目标的个人和社会障碍。参与者赞成设定结构化目标、使用在线社交网络以及提供经济奖励作为促进健康生活方式的手段。同伴被视为比家庭成员更好的激励因素。
一个积极的沟通框架，包括传播与饮食和运动相关的健康信息、设定结构化目标、同伴责任追究和经济奖励，在心力衰竭管理中似乎很有前景。
