Development of a Values-Affirmation Intervention Targeting Medication Adherence in Older Adults with Heart Failure Completing Cardiac Rehabilitation

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PROJECT SUMMARY/ABSTRACT Aging adults, particularly those managing a chronic illness, face numerous challenges navigating changing roles and functional abilities. Heart failure (HF) is prevalent among older adults and requires complex, long- term disease management. Rehospitalizations are common, and often result from inadequate medication ad- herence. Encouraging a connection between medication-taking and an individual’s core values may reframe medication use as a self-guided effort to engage in personally meaningful living. Values-affirmation (e.g., inviting patients to reflect on important core values) can promote openness to health behavior change, and may be a powerful motivational tool to enhance education and behavior skills adherence interventions. This application proposes to develop a novel values-affirmation intervention to improve medication adherence in HF patients enrolled in cardiac rehabilitation. The proposed Mentored Patient-Oriented Research Career Develop- ment Award (K23) will provide Dr. Emily Gathright critical training in the development and evaluation of behavioral self-management interventions for older adults with HF. Training in (1) biopsychosocial as- pects of aging, (2) use of qualitative methods to guide theory-driven intervention development, (3) randomized controlled trial (RCT) design and execution, (4) RCT analysis, and (5) professional development will bridge prior training in psychosocial and behavioral determinants of prognosis in HF to interventions that improve out- comes for older adults with chronic illness. Dr. Gathright will benefit from the support of a robust mentorship team with complementary strengths and extensive experience leading federally-funded research. Expert men- torship will be provided by leading scientists in the fields of aging and cognition, preventive cardiology, biosta- tistics and methodology, behavioral interventions, qualitative methods, and pharmacoepidemiology. The Cen- ters for Behavioral and Preventive Medicine at The Miriam Hospital (a Center of Excellence at the Alpert Medi- cal School of Brown University) and Alpert Medical School’s Department of Psychiatry and Human Behavior offer an impressive training environment with a strong record of successful completion of K awards. Dr. Gath- right will develop a values-affirmation medication adherence intervention through three aims: (1) Focus groups (6-8; N = 30-48) will be conducted to identify core values most relevant to HF medication adherence, and to guide the development of a combined values-affirmation and skills-building intervention; (2) Intervention feasi- bility and acceptability will be evaluated and refined following a small, open trial (N = 12); and (3) Intervention feasibility, acceptability, and preliminary efficacy will be examined using a pilot RCT (N = 50) comparing the intervention to a no-treatment control group. The project will lay the foundation for a subsequent RCT to evalu- ate efficacy and mechanisms of action. The K23 proposal provides clear and achievable training and research plans that will move Dr. Gathright toward her goal of becoming an independent, clinical researcher developing novel and innovative approaches to improve disease management for older adults with chronic illness.