Who Signs Up for and Engages in a Peer Support Heart Failure Self-management Intervention.

Background: Many programs for patients with heart failure (HF) fail to improve clinical outcomes in part because of low rates of patient enrollment and engagement. A better understanding of patient characteristics associated with willingness to enroll and then engage in HF self-management programs will improve the design and targeting of programs.

Methods And Results: Analyses of screening, baseline, and engagement data from a randomized controlled effectiveness trial of an HF peer self-management support program were conducted. The median age of the 266 recently hospitalized HF patients who enrolled in the study was 69 years, 51% were female, and 26% were minorities (primarily African American). Of 135 randomized to the peer support intervention, only 39% engaged in either the group sessions or telephone peer support calls. Older white women who reported higher baseline health status, functioning, social support, and confidence in their ability to manage and less difficulty with the physical and emotional aspects of living with HF were the most likely to engage in program activities. Minority status and reporting a need for social support were both correlated with higher enrollment but lower engagement in the intervention.

Conclusions: Although minority patients with poorer reported health status and social support were most likely to consent to participate in the study, participants who engaged in program activities were more likely to have higher baseline health status, functioning, and social support. Developing HF interventions that successfully engage participants most in need of HF self-management support remains a difficult challenge.