title: A randomized trial of mobile health support for heart failure patients and their informal caregivers: impacts on caregiver-reported outcomes.
abstract: BACKGROUND
  Mobile health services may improve chronic illness care, but interventions rarely support informal caregivers' efforts.
  
  
  OBJECTIVE
  To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management.
  
  
  METHODS
  Randomized comparative effectiveness trial.
  
  
  METHODS
  A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system. All patients participated with a "CarePartner" or informal caregiver outside their household.
  
  
  METHODS
  Patients randomized to "standard mHealth" received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians. "mobile health+CarePartner" (mHealth+CP) patients received identical services, plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners.
  
  
  METHODS
  At baseline, 6, and 12 months, CarePartners completed assessments of caregiving strain, depressive symptoms, and participation in self-care support.
  
  
  RESULTS
  mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months (both P≤0.03). That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline (P≤0.03 for interactions between arm and baseline strain/depression at both endpoints). Although most mHealth+CP CarePartners increased the amount of time spent in self-care support, those with the highest time commitment at baseline reported decreases at both follow-ups (all P<0.05). mHealth+CP CarePartners reported more frequently attending patients' medical visits at 6 months (P=0.049) and greater involvement in medication adherence at both endpoints (both P≤0.032).
  
  
  CONCLUSIONS
  When CarePartners experienced significant caregiving strain and depression, systematic feedback about their patient-partner decreased those symptoms. Feedback also increased most CarePartners' engagement in self-care.
authors.affiliation: *Ann Arbor Department of Veterans Affairs Center for Clinical Management Research †Department of Health Behavior and Health Education, School of Public Health, University of Michigan ‡Department of Internal Medicine, School of Medicine, University of Michigan §Department of Family Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Dana
authors.initials: D
authors.lastname: Striplin
authors.forename: Nicolle
authors.initials: N
authors.lastname: Marinec
authors.forename: Jenny
authors.initials: J
authors.lastname: Chen
authors.forename: James E
authors.initials: JE
authors.lastname: Aikens
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000379:methods*; D011788:Quality of Life; D012648:Self Care / Q000379:methods; D012944:Social Support; D017216:Telemedicine; D013689:Telephone