Background: Computerized cognitive training (CCT) interventions may have an important role in improving cognition among patients with heart failure. Ensuring treatment fidelity of CCT interventions is an essential part of testing their efficacy. Objective: The aim of this study was to describe facilitators of and barriers to treatment fidelity perceived by CCT intervenors while delivering the interventions to patients with heart failure. Methods and Results: A qualitative descriptive study was completed with 7 intervenors who delivered CCT interventions in 3 studies. Directed content analysis revealed 4 main themes of perceived facilitators: (1) training for intervention delivery, (2) supportive work environment, (3) prespecified implementation guide, and (4) confidence and awareness. Three main themes were identified as perceived barriers: (1) technical issues, (2) logistic barriers, and (3) sample characteristics. Conclusion: This study is novel because it was one of the few studies focused on the intervenors' perceptions rather than the patients' perception of using CCT interventions. Beyond the treatment fidelity recommendations, this study found new components that might help the future investigators in designing and implementing CCT interventions with high treatment fidelity.
Introduction: The associations of cognition with self-care of heart failure (HF) or with health-related quality of life (HRQL) have not been definitively established, Gender may moderate these associations. The aim of our study was to examine the associations between cognition and (1) HF self-care and (2) HRQL and explore (3) gender as a moderator. Methods: Baseline data were analyzed from a randomized trial of a cognitive intervention (N=73). A neuropsychological battery was used to assess cognition (i.e., global cognition, memory, attention, executive function, language). Self-Care of Heart Failure Index and Minnesota Living with Heart Failure were used to assess self-care (i.e., maintenance, management, perception, confidence) and HRQL, respectively. Moderated multiple regressions were performed using Hayes’ PROCESS macro v4.1 with cognition as the independent variable, gender as the moderator, and HF self-care or HRQL as dependent variables in separate models. Covariates were age and education. Results: Participants’ characteristics were: mean age=66±12 years; mean education=14±2 years; 56% women; mean LVEF=50±14%. Average scores were: self-care maintenance=68±12, management=64±16, perception=74±16, confidence=78±13, HRQL=29±22. Better attention scores were significantly associated with better self-care confidence (b=-1.002, p=.022). Gender moderated the relationships between attention and self-care perception (p=.030). Better attention was associated with better self-care perception among women but with worse self-care perception among men. Gender moderated the relationships between memory and HRQL (p=.050) as well as executive function and HRQL (p=.041). Women’s HRQL did not differ by memory or executive function, but men with better memory or executive function had better HRQL. Conclusion: Better attention was associated with better self-care confidence in HF. Associations between attention and self-care perception, memory and HRQL, and executive function and HRQL differed by gender. Interventions are needed to improve attention, memory, and executive function that may improve HF self-care and HRQL. The effects of gender need to be considered when designing future interventions.
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