Intervention mediating effects of self-efficacy on patient physical and psychological health following ICD implantation

This study examined mechanisms by which social cognitive theory (SCT) interventions influence health outcomes and the importance of involving partners in recovery following the patients' receipt of an initial implantable cardioverter defibrillator (ICD). We compared direct and indirect intervention effects on patient health outcomes with data from a randomized clinical trial involving two telephone-based interventions delivered during the first 3 months post-ICD implant by experienced trained nurses: P-only conducted only with patients, and P + P conducted with patients and their intimate partners. Each intervention included the patient-focused component. P + P also included a partner-focused intervention component. ICD-specific SCT-derived mediators included self-efficacy expectations, outcome expectations, self-management behavior, and ICD knowledge. Outcomes were assessed at discharge, 3- and 12-months post ICD implant. Patients (N = 301) were primarily Caucasian, male, 64 (+/- 11.9) years of age with a mean ejection fraction of 34.08 (+/- 14.3). Intervention effects, mediated through ICD-specific self-efficacy and outcome expectations, were stronger for P + P compared to P-only for physical function (beta = 0.04, p = 0.04; beta = 0.02, p = 0.04, respectively) and for psychological adjustment (beta = 0.06, p = 0.04; beta = 0.03, p = 0.04, respectively). SCT interventions show promise for improving ICD patient physical and psychological health outcomes through self-efficacy and outcome expectations. Including partners in post-ICD interventions may potentiate positive outcomes for patients. Trial registration number (TRN): NCT01252615 (Registration date: 12/02/2010)

Automated summary

This study examined the impact of social cognitive theory (SCT) interventions on health outcomes of patients receiving an initial ICD implant, highlighting the importance of involving partners in the recovery process. Results showed that interventions including partners (P + P) had stronger effects on physical function and psychological adjustment compared to interventions with patients only (P-only), mediated through self-efficacy and outcome expectations specific to ICD. Including partners in post-ICD interventions may lead to more positive outcomes for patients.