This proposal is for a multi-method study examining social support process in the management of chronic congestive heart failure. 187 married CHF patients and their spouses will be interviewed and engage in a videotaped interaction. The comparison group will be family practice patients matched for age and non-heart chronic health conditions. At 4, 8, and 12 months, these couples will again be assessed with regard to support, self-efficacy, psychological functioning, adherence, and a range of marital variables. Additionally, there will be another videotaped interaction at 8 months, and structured daily diaries sampling three 1-week periods. Medical utilization, costs, and complicating events will be monitored throughout the years and a number of measures of cardiovascular functioning with established prognostic significance in CHF assessed. The primary research aim of the study is to describe the effects of involvement in social relationships on self-efficacy, psychological functioning, adherence, and medical utilization in chronic CHF, and indirectly on measures of cardiovascular functioning. Because of the importance of marriage and the spouse in the management of CHF, the study will incorporate a multi-method assessment, including interviews, structured daily diaries, brief speech samples, and behavioral observation, and it will compare these sources of data on the marriage as means of describing of support processes and as predictors of outcome. The study will identify a set of initial factors indicating CHF patients who will subsequently be a risk because of deficiencies in social support. The study will also identify factors influencing the vulnerability, participation in patient care, and effectiveness of the spouse as a support provider. Finally, the study will provide insights into the effects of social relationships on the concurrent association between measures of cardiovascular functioning and quality of life. The prevalence and mortality associated with CHF are increasing rapidly. Although management is complex and demanding of patient and family, and nonadherence is costly and life-threatening, there is a dearth of psychosocial research concerning CHF. Results of the proposed research will have crucial implications for the routine management of CHF and the design of adherence-enhancing interventions. The research will also make a more general contribution to the understanding of support processes in the management of chronic illness and the links between involvement in close relationships, adherence and biomedical outcomes in particular.
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