title: The effect of progressive, reinforcing telephone education and counseling versus brief educational intervention on knowledge, self-care behaviors and heart failure symptoms.
abstract: BACKGROUND
  The optimal strategy for promoting self-care for heart failure (HF) is unclear.
  
  
  RESULTS
  We conducted a randomized trial to determine whether a "teach to goal" (TTG) educational and behavioral support program provided incremental benefits to a brief (1 hour) educational intervention (BEI) for knowledge, self-care behaviors, and HF-related quality of life (HFQOL). The TTG program taught use of adjusted-dose diuretics and then reinforced learning goals and behaviors with 5 to 8 telephone counseling sessions over 1 month. Participants' (n = 605) mean age was 61 years; 37% had marginal or inadequate literacy; 69% had ejection fraction <0.45; and 31% had Class III or IV symptoms. The TTG group had greater improvements in general and salt knowledge (P < .001) and greater increases in self-care behaviors (from mean 4.8 to 7.6 for TTG vs. 5.2 to 6.7 for BEI; P < .001). HFQOL improved from 58.5 to 64.6 for the TTG group but did not change for the BEI group (64.7 to 63.9; P < .001 for the difference in change scores). Improvements were similar regardless of participants' literacy level.
  
  
  CONCLUSIONS
  Telephone reinforcement of learning goals and self-care behaviors improved knowledge, health behaviors, and HF-related QOL compared to a single education session.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. dbaker1@nmff.org
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Darren A
authors.initials: DA
authors.lastname: Dewalt
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Victoria
authors.initials: V
authors.lastname: Hawk
authors.forename: Bernice
authors.initials: B
authors.lastname: Ruo
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Aurelia
authors.initials: A
authors.lastname: Macabasco-O'Connell
authors.forename: Kathy L
authors.initials: KL
authors.lastname: Grady
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
authors.forename: Brian
authors.initials: B
authors.lastname: Erman
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Broucksou
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
mesh_terms: D003376:Counseling; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D015438:Health Behavior; D006333:Heart Failure / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care; D012720:Severity of Illness Index; D017216:Telemedicine; D016896:Treatment Outcome
chemical_list: D004232:Diuretics