Heart Failure Patients’ Dietary Adherence Social and Community Factors Shaping Information, Motivation, and Behavioral Skills in Heart Failure Patients’ Dietary Adherence Amanda M. McDougald Scott, MS1,2 and Richard J. Holden, Ph.D.1, 1Department of Medicine, Department of Biomedical Informatics, 2 Clemson University, INFL, PhD Student Objective IMB Themes Found Findings Social: “I didn’t really associated that with my heart because I had eaten a whole lot of stuff that weekend. I had been out of town and I ate a whole lot of barbecue and drunk some beer and did all that and I said maybe that’s what it is you know and so, I didn’t even think about the heart. I thought it was my indulgent behavior.” Heart failure is a global, deadly, and expensive disease. Patients with heart failure must overcome a complex set of behavioral and attitudinal obstacles if they wish to live longer than the average 5 years post-diagnosis. Adherence to a restricted sodium diet is a major challenge facing heart failure patients. The knowledge possessed (or lack thereof) by heart failure patients regarding sodium restricted is linked to their adherence to restricted sodium diets. Patients may believe that they are following a low-sodium diet, urinary sodium levels and self-reports indicate that they are not. Our two objectives were to (1) identify Information, Motivation, and Behavioral skill-related (IMB) barriers to dietary adherence (2) understand how these barriers were shaped by patients’ social and community contexts. The Information, Motivation, and Behavioral (IMB) skills model demonstrates a framework of constructs that may lead to adherence behavior. Information can lead to greater motivation, and motivation can lead to acquiring more information. This dynamic can lead to behavioral skills, which can lead to adherence behavior as indicated in the figure below. Social: “If I’m not cooking my own meals and if I go out to dinner or I go to somebody else’s house to eat and I don’t know what they put into it.” Information: Interviewer: “Did it (eating potato chips) make your feet swell or anything like that?” Patient: “No, it didn’t.” Interviewer: “Ok, no?” Participant: “It should, it didn’t. Potatoes, now potatoes you know they say I’m not supposed to eat a whole lot of.” Culture/Community: Patient: I know it. How can you leave banana pudding alone once you see it? You can’t, or I can’t, you know I just-- Interviewer: Well what do you try to do? Do you try to keep it out of the house? Do you try not to look at it or what? Patient: Most of the time I don’t, but it’s hard to look at ‘em beans and not have a bowl full of them. Interviewer: Yeah. Patient: Corn, fried okra and stuff like that. I mean you don’t, you just uh, well, it’s kinda, it’s food that I’ve been eating. I told (Husband) uh, I don’t know when it was, I said, (Husband) this is food that we’ve been eating all our lives and I said, we still like it, you know, ain’t nothing wrong with it except a lot of people eat too much of it you know and I can tell when, I can tell when uh, uh, I’m eating too much and I just cut it off you know I just, I just quit. Behavioral Skills: Caregiver: “..you read that can.” Interviewer: “Yeah, you look at the labels..” Caregiver: “It’ll say sodium. It won’t say salt, but that’s the same.” IMB Model Conclusion Social and community programs should consider cultural, ethnic, and social barriers when making recommendations to patients about dietary changes. Patients’ environment and context should be considered so that reachable and reasonable goals can be established for patients with difficult and complex diseases such as chronic heart failure. Perhaps when these issues are taken into consideration, the information, behavior, and motivation will be facilitated and an improvement may be realized in dietary alterations as difficult as sodium restriction. Note. Social/Community Influence is an adapted construct added onto the current IMB constructs by the author. This addition is proposed as part of the “Moderating Factors Affecting Adherence” from the IMB model. Method This study investigates the barriers to dietary adherence and how these barriers were shaped by social and community contexts of 30 geriatric heart failure patients’ self-care. Acknowledgements & references Thank you to patient, family, and clinician participants in the “Caring Hearts” study. N=30 chronic heart failure patients, N=14 lay caregivers. Patients aged ≥65, M=74±6.5, 57% male, 60% White. Eligible if English-speaking, NYHA Class II or III heart failure, and seeing a cardiologist for outpatient care. Initial (30min) and follow-up in-home (90min) interviews, surveys (100% RR), observation of outpatient clinic visit, and medical record review. This study is sponsored by NIH/NCATS grant 2KL2TR000446-06 through the Vanderbilt Institute for Clinical and Translational Research (VICTR). Fisher’s (2006) information-motivation-behavioral (IMB) skills model. Solid lines indicate effects, while the dashed line denotes a feedback loop. When health outcomes are good or improve, this may reinforce the pattern of IMB. References