Evidera PPD Inc., Patient Centered Research, London, UK.
Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA.
J Behav Med. 2021 Dec;44(6):842-852. doi: 10.1007/s10865-021-00244-8. Epub 2021 Jul 23.
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).
本研究旨在探讨社会认知理论（SCT）干预影响健康结果的机制，以及在患者接受初始植入式心脏复律除颤器（ICD）后让伴侣参与康复的重要性。我们比较了直接和间接干预对患者健康结果的影响，数据来自一项随机临床试验，该试验涉及在 ICD 植入后 3 个月内由经验丰富的训练有素的护士进行的两项基于电话的干预：仅针对患者的 P 干预和针对患者及其亲密伴侣的 P+P 干预。每项干预都包括以患者为中心的部分。P+P 还包括一个以伴侣为中心的干预部分。ICD 特异性 SCT 衍生的中介因素包括自我效能期望、结果期望、自我管理行为和 ICD 知识。结果在 ICD 植入后出院时、3 个月和 12 个月进行评估。患者（N=301）主要为白种人，男性，64（±11.9）岁，平均射血分数为 34.08（±14.3）。通过 ICD 特异性自我效能和结果期望进行中介的干预效果，P+P 比 P 仅对身体功能（β=0.04，p=0.04；β=0.02，p=0.04）和心理调整（β=0.06，p=0.04；β=0.03，p=0.04）更有效。SCT 干预通过自我效能和结果期望显示出改善 ICD 患者身体健康和心理健康结果的潜力。让伴侣参与 ICD 后干预可能会增强患者的积极结果。试验注册号（TRN）：NCT01252615（注册日期：2010 年 12 月 2 日）。
