title: An internet-based intervention to improve psychosocial outcomes in heart transplant recipients and family caregivers: development and evaluation.
abstract: BACKGROUND
  Although quality of life (QOL) is generally improved by heart transplantation, medical noncompliance and mental health and QOL limitations often emerge and persist. Transplant teams' ability to address these issues is hampered because many patients reside long distances from the transplant program. We therefore conducted the first empirical evaluation of an internet-based psychosocial intervention for heart recipients and their families.
  
  
  METHODS
  Based on focus group work and previous research, a multifaceted web-based intervention was developed with stress and medical regimen management workshops; monitored discussion groups; access to electronic communication with the transplant team; and information on transplant-related health issues. Intervention effectiveness was evaluated with 20 patients and family caregivers who used the website for 4 months (plus usual clinical care). Pre- and post-intervention assessments of mental health, QOL and medical compliance were performed. Comparison groups of 40 patients and their caregivers who received only usual care were similarly assessed.
  
  
  RESULTS
  Relative to the comparison groups, intervention patients' depressive and anxiety symptoms, and caregivers' anxiety and hostility symptoms declined significantly (P < 0.05). QOL in social functioning significantly improved. Mental health and QOL benefits were greater among more frequent users of the website. Overall, intervention patients' medical compliance did not change. However, the sub-group using the website's medical regimen workshop showed significantly better compliance at follow-up than all other patients in attending clinic appointments, completing blood work and following diet.
  
  
  CONCLUSIONS
  These preliminary findings suggest that a web-based intervention could have a vital role in follow-up care and in patients' and families' adjustment to heart transplantation.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania 15213, USA. dewma@msx.upmc.edu
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Jean M
authors.initials: JM
authors.lastname: Goycoolea
authors.forename: Ronna C
authors.initials: RC
authors.lastname: Harris
authors.forename: Ann
authors.initials: A
authors.lastname: Lee
authors.forename: Rachelle
authors.initials: R
authors.lastname: Zomak
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Dunbar-Jacob
authors.forename: Armando
authors.initials: A
authors.lastname: Rotondi
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D005260:Female; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D020407:Internet; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D016730:Program Development; D015397:Program Evaluation; D011788:Quality of Life; D012944:Social Support; D016896:Treatment Outcome