The Effectiveness of Cognitive-Behavioral Therapy Based on Healthy Lifestyle on Self-Care Improvement in Patients With Heart Failure

Cardiovascular disease is the most common cause of death and disability in most countries, including Iran. Reduced self–care skills in cardiac patients and their frequent hospitalizations is the main challenge. Lifestyle can refer to the interests, opinions, behaviors, and behavioral orientations of an individual, group, or culture. Self–care is a practice in which people use their knowledge, skills, and power as a source to take care of their health independently. Self–care is about self–determination and self–reliance. One of the treatment options for cardiovascular diseases is cognitive–behavioral therapy, which is provided in the form of appropriate training. Without such interventions, heart disease causes substantial economic costs and increases the duration of the disease. Accordingly, numerous side effects in various physical and psychological fields will be expected. This study aimed to evaluate the effectiveness of cognitive–behavioral therapy based on a healthy lifestyle on self–care improvement in patients with heart failure.

The research method was quasi–experimental with a pretest–posttest and two–month follow–up design with a control group. The study population comprised patients with heart failure referred to Shafa Hospital in Kerman City, Iran, from summer 2013 to spring 2014. Considering the significance level of 0.05 and test power of 0.80, the required sample size for each experimental and control group was estimated to be 15, using G*Power software. Therefore, after coordination with Shafa Hospital authorities, 30 patients who met the inclusion criteria and were willing to cooperate were randomly selected as the final sample. They were the patients referred to that hospital after assessing the comorbidity of mental disorders using structured clinical interviews. They were then randomly assigned to the experimental and control groups. The inclusion criteria for patients were as follows: having heart failure, not receiving psychotherapy from other centers at the same time, and not suffering from acute personality disorders, such as schizophrenia, obsessive–compulsive disorder, hospitalization, and treatment under the supervision of a physician. It is worth mentioning that during the treatment sessions in the experimental group, 4 patients refused to continue their study due to travel and working conditions. In the end, the sample size of the experimental group was reduced to 11 people. The experimental group underwent psychotherapy with cognitive–behavioral therapy. In contrast, the control group did not receive any treatment. The experimental group was under the administration of healthy lifestyle promotion intervention via cognitive–behavioral therapy of eight group sessions once a week. A demographic questionnaire was used to match the participants of the two groups. Variables such as age, gender, socioeconomic status, associated clinical disorders, dosage, and type of treatment were assessed using this questionnaire. Self–care was measured for all participants in three phases of pretest, posttest, and follow–up by the European Heart Failure Self–Caring Behaviors Scale (EHFScBs) (Jaarsma et al., 2009). Data analysis was performed with descriptive (mean, standard deviation, and graph) and inferential statistics (repeated measures analysis of variance and Tukey's post hoc test) in SPSS version 19 software. The significance level of the tests was considered to be 0.05.

The results showed that the effects of time (p=0.001) and time *group (p=0.001) on the self–care variable were significant. Also, the cognitive–behavioral therapy based on a healthy lifestyle significantly affected the self–care of the experimental group compared to the control group (p=0.001). In addition, in the experimental group, a significant difference was observed between the average scores of the self–care variable in the pretest and posttest stages (p=0.025). However, there was no significant difference between the average scores of the mentioned variable in the posttest and follow–up stages (p=0.280), indicating the persistent effect of the intervention up to the follow–up stage.

According to the study findings, due to the importance of heart patients' lifestyles, the cognitive–behavioral based on a healthy lifestyle can improve the ability of self–care in heart patients.