Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychology, Northwestern University, Chicago, IL, USA.
J Psychosom Res. 2020 Dec;139:110285. doi: 10.1016/j.jpsychores.2020.110285. Epub 2020 Oct 29.
Most patients with heart failure (HF) struggle to adhere to health behaviors, and existing health behavior interventions have significant limitations. We developed a 12-week, phone-delivered, combined positive psychology (PP) and motivational interviewing (MI) intervention to promote well-being and adherence to physical activity, diet, and medications. In this three-arm, randomized trial, we assessed the feasibility, acceptability, and preliminary efficacy of the intervention compared to treatment as usual and MI-alone conditions in 45 patients with HF and suboptimal health behavior adherence.
Participants in the PP-MI or MI-alone conditions completed weekly phone sessions for 12 weeks. Those in PP-MI completed weekly PP exercises and set health behavior goals, while those in the MI-alone condition learned about HF-specific health behaviors and identified potential behavior changes. Primary study outcomes were feasibility (sessions completed) and acceptability (0-10 ratings of PP exercise ease and utility). The intervention's impact on psychological and behavioral outcomes was assessed using mixed effects regression analyses.
Participants in the PP-MI condition completed 73% of sessions and rated PP exercises as easy to complete (mean = 7.5 [SD 1.7] out of 10) and subjectively useful (mean = 7.5 [SD 1.6] out of 10). Compared to the control conditions, PP-MI led to medium effect-size improvements in positive affect (Cohen's d = 0.32-0.77), moderate to vigorous physical activity (d = 0.41-0.74), and medication adherence (d = 0.48-0.78).
This PP-MI intervention was feasible, well-accepted, and associated with promising improvements in well-being and health behavior outcomes. Larger trials are needed to examine this intervention's impact on health behavior adherence and other important outcomes (NCT03220204).
大多数心力衰竭（HF）患者在坚持健康行为方面存在困难，现有的健康行为干预措施存在明显的局限性。我们开发了一种为期 12 周的电话传递的结合积极心理学（PP）和动机访谈（MI）的干预措施，以促进幸福感并促进身体活动、饮食和药物的依从性。在这项三臂随机试验中，我们评估了该干预措施与常规治疗和 MI 单一条件相比在 45 名 HF 和健康行为依从性差的患者中的可行性、可接受性和初步疗效。
PP-MI 或 MI 单一条件的参与者每周完成 12 周的电话会议。PP-MI 组完成每周的 PP 练习并设定健康行为目标，而 MI 单一条件组则了解 HF 特定的健康行为并确定潜在的行为改变。主要研究结果是可行性（完成的课程）和可接受性（PP 练习的难易程度和效用的 0-10 评分）。使用混合效应回归分析评估干预对心理和行为结果的影响。
PP-MI 组完成了 73%的课程，并对 PP 练习的完成难易程度进行了评分（平均值= 10 分中的 7.5 分[SD 1.7]）和主观有用性（平均值= 10 分中的 7.5 分[SD 1.6]）。与对照组相比，PP-MI 导致积极情绪（Cohen's d= 0.32-0.77）、中等到剧烈的身体活动（d= 0.41-0.74）和药物依从性（d= 0.48-0.78）的中等至较大效应量改善。
这种 PP-MI 干预措施是可行的，易于接受的，并与幸福感和健康行为结果的改善有关。需要更大规模的试验来检验该干预措施对健康行为依从性和其他重要结果的影响（NCT03220204）。
