Heart failure (HF) emerged as a significant public health threat in the 1990s and has now reached epidemic proportions. Despite advances in the medical treatment of HF, patients with HF face frequent hospitalizations for acute exacerbations. Inadequate self-care strategies, in particular non-adherence to a sodium restricted diet (SRD), are a main cause of these hospitalizations. Prior interventions to increase adherence have focused on increasing knowledge about restricting sodium in the diet have met with limited success. Unaddressed by these interventions are the major barriers of measuring and tracking daily sodium intake, family members who continue to eat high sodium diets, and a preference for salty foods-particularly in the elderly who have a decreased sense of taste. It is possible to retrain the taste buds to enjoy low salt foods by gradually reducing the amount of sodium in foods over the course of 16 weeks. This retraining works best with direct involvement and support from family members. The Family Sodium Watcher Program (Family Swap) proposed in this study incorporates the use of a unique electronic salt monitoring device that easily measures salt content in food-the major source of sodium. The intervention is designed to improve adherence to a SRDby both patients and family caregivers through education and strategies for gradual taste adaptation to low salt foods. The purpose of this 2-group randomized, controlled, repeated measures (baseline, 4-month, and 12-month) study is to examine effects of Family Swap on adherence (24-hour urine sodium excretion) to a SRD;knowledge, attitudes, and barriers about SRD;perceived control and perceived social support (in patient- caregiver dyads);caregiving burden (in caregivers only);and symptom distress and hospitalizations (in patients only). We will enroll a total of 220 patient-caregiver dyads. Dyads will be stratified as adherent and non-adherent using baseline patients'24-hour urine sodium excretion (cut point = 3000 mg) and then randomly assigned to Family Swap intervention group or a usual care control group. The Family Swap intervention (6 weekly 45-minute sessions followed by 5 bi-weekly booster sessions) will be delivered remotely using a video- conferencing program on an iPad tablet. Patient-caregiver dyads will complete questionnaires (knowledge, attitudes, and barriers about diet;symptoms distress;perceived control;perceived social support;caregiving burden;and quality of life) and collect a 24-hour urine for sodium excretion at each assessment. Data will be analyzed using repeated measures ANOVA, Cox regression, and an innovative actor-partner interdependence model dyadic analysis for longitudinal data. This dyadic intervention study will provide rich data on the complex, interpersonal relationships within patient-caregiver dyads that affect adherence and health outcomes in patients with HF and family caregivers. Given the recommendation that all individuals should consume a sodium restricted diet, the intervention has the potential for expanded application beyond patients who need to follow a sodium restricted diet for cardiovascular reasons to everyone consuming a diet high in sodium.

Public Health Relevance

With the rising costs of health care, family members are playing a greater role in the care of chronically ill patients. This family-based intervention addresses the public health goal of improving the health status and quality of life of patients wit heart failure and their family caregivers through an innovative educational program focused on the self-care of sodium restricted diet.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Huss, Karen
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University of Kentucky
Schools of Nursing
United States
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