The long-term goal of this research is to reduce morbidity and improve HF self-care by
enhancing family problem-solving and collaborative care management among rural HF dyads. The
initial step in meeting this goal is to develop and pilot-test a culturally-sensitive,
telephone-based, tailored dyadic problem-solving intervention to improve HF self-care in
rural HF dyads. Using a multi-phase, sequential qualitative and quantitative approach, the
following research aims are to: 1) identify the major dyadic HF-related problems dyads
experience and how these problems are managed; 2) develop a telephone-based, tailored dyadic
problem-solving intervention and determine its feasibility and acceptability for managing
HF-related problems; and 3) evaluate the preliminary effects of the telephone-based, tailored
dyadic problem-solving intervention on dyadic problem-solving and patient and family
caregiver contributions to HF self-care. As an exploratory aim, we will also evaluate the
effectiveness of the dyadic problem-solving intervention on caregiver burden, self-care, and
life changes. In Phase I, qualitative inquiry will guide in-depth semi-structured dyad
interviews (n = 12-20 dyads; 24-40 participants) to identify the dyadic HF-related problems
experienced by rural HF dyads and associated management strategies (Aim 1). Phase II will be
guided by qualitative and quantitative methods and include a repeated measures, single-group
design to evaluate the feasibility, acceptability, and preliminary effectiveness of the
12-week dyadic problem-solving intervention in a sample of rural HF dyads (n = 60 dyads; 120
participants) (Aims 2, 3). Participants for this study will be recruited from from the
Florida State University Institute for Successful Longevity Participant Registry, outpatient
HF/cardiac and rural healthcare clinics affiliated with Tallahassee Memorial Hospital, Bond
Community Health Clinic, via social medial and newspaper ads, and publicly available
community sites (e.g., senior centers, post offices, grocery stores, etc.).
Phase I (Arm 1) will identify dyadic HF-related problems and management strategies using
semi-structured interviews in a sample of rural-residing HF dyads (n = 12-20 dyads; 24-40
participants). Following consent, interviews will occur once and be approximately 45 minutes
long. Qualitative data from Phase I will be analyzed using thematic analytic methods and
NVivo11. Information gained in Phase I will be used to develop the telephone-based, tailored,
dyadic problem-solving intervention for rural HF dyads tested in Phase II.
Phase II (Arm II) will be guided by qualitative and quantitative inquiry and include a
single-group, repeated measures design with time and dyad-member as within-subject factors. A
sample size of 60 dyads (120 participants) is desired based on a power analysis for repeated
measures ANOVA with 4 time points, alpha level of .05, a medium effect size (f = 0.25), and
80% power, plus oversampling for potential attrition (20%). Following verbal informed consent
via telephone, all dyads will be screened for cognitive impairment using the Telephone
Interview for Cognitive Status (TICS) prior to baseline data collection, which will include a
Sociodemographic and Clinical Survey, the Self-Care of HF Index (SCHFI; v. 6.2) (patients
only), the Caregiver Contribution to the Self-Care of HF Index (CCSCHFI) (caregivers only),
Healthcare Utilization Survey, the Social Problem-Solving Inventory Revised-Short (SPSIRS),
the Center for Epidemiological Studies-Depression (CESD), the Global Family Function Subscale
(GFF) of the Family Assessment Device Questionnaire, and the Interpersonal Support Evaluation
List-12 (ISEL-12). Caregivers will also complete the Dutch Objective Burden Inventory (DOBI),
Denyes Self-care Practice Instrument (DENYES), and the BAKAS Caregiving Outcomes Scale
(BAKAS).
Using a single group design, all dyads will participate in a problem-solving training
intervention over 12 weeks (Weeks 1-4, 6, 8, 10, 12), with follow-up data collection
occurring at weeks 5, 9, 11, 13. Qualitative data will be collected at weeks 5 and 11 via
semi-structured interviews with dyads. Quantitative data on study outcomes and covariates
will be collected at weeks 5, 9, and 13 and consist of the SCHFI (patient), CCSCHFI
(caregiver), healthcare utilization (patient), SPSIRS (dyad), REALM (dyad), CESD (dyad), GFF
(dyad),ISEL-12 (dyad), DOBI (caregiver), Denyes (caregiver) and the BAKAS (caregiver). All
data will be self-report and collected by a trained research assistant who will collect study
data over the telephone and mark participants answers on a computerized data spreadsheet.
Qualitative data will be analyzed using thematic analytic methods and NVivo11. Possible
treatment effectiveness on dyadic problem-solving, patient and caregiver contributions to HF
self-care, healthcare utilization, caregiver burden, caregiver self-care, caregiver life
changes, and differences among subgroups (gender, relationship type) over the 13 weeks will
be examined using multilevel modeling and dyadic Growth Curve Modeling (GCM).
