Hopelessness has been identified in 27% of patients with ischemic heart disease (IHD), can persist for up to 12 months after hospital discharge (Dunn et al., 2017), and is associated with a 3.4 times increased risk of mortality or nonfatal myocardial infarction (Freedland et al., 2009; Pederson et al., 2007). Conversely, the concept of hope has been linked with positive health outcomes in chronically ill populations (Duggleby, et al., 2012; Madan & Pakenham, 2014). Hope is defined as a positive motivational state or trait consisting of a sense of successful agency (goal-directed energy) and pathways (one's capacity to generate a plan to reach goals) (Snyder, 2000). State hope is one’s goal directed thinking in any given moment and situation, whereas trait hope is a person’s disposition or general way of goal directed thinking (Snyder, 2000). State and trait hope have not been examined in IHD patients. The purpose of this study was to 1) describe state and trait hope in a sample of hopeless IHD patients and 2) evaluate the preliminary efficacy of a 6-week intervention, called Heart Up!, in improving state hope in hopeless IHD patients. This study was based on Self-Determination Theory (SDT) (Deci & Ryan, 2008) and Cohen’s Stress and Coping Social Support Theory (Cohen, Gottlieb & Underwood, 2001). The Heart Up! intervention’s motivational interviewing session, based on SDT, provided a supportive environment to enhance competence, autonomy, and relatedness, leading to intrinsic motivation. The Heart Up! intervention’s text messages were developed based on SDT and within Cohen’s social support category of emotional support, focusing on encouragement.
Methods:
Patients hospitalized for an IHD event at a single hospital in the Midwestern United States were screened for hopelessness. Patients who reported moderate to severe state hopelessness, and who had a cellphone with text messaging capability, were eligible for the study. Patients consenting to the study were randomized to one of 3 groups; 1) motivational social support (MSS) from a nurse, 2) MSS from a nurse with social support from a significant other (SOS), or 3) attention control (AC). The MSS and MSS-SOS groups participated in a motivational interviewing session with a nurse in week 1, followed by daily, automated text messages from the nurse for 6 weeks. The MSS-SOS group also received text messages from their significant other. The AC group participated in a question-answer session with a trained data collector. Data were collected at baseline (week 1 after hospital discharge) and at 8 weeks. Patients were screened for hopelessness using the state subscale of the State-Trait Hopelessness Scale (Dunn et al., 2014). The Snyder Trait and State Hope Scales (Snyder, 2000) were used to measure hope.
Results:
Thirty patients with moderate to severe state hopelessness were enrolled into the pilot study and 67% (n= 20) completed the study. State hope significantly improved in the 20 patients from baseline (mean= 30.6, SD= 10.03) to 8 weeks (mean= 35.75, SD 7.95, p= 0.005). There was no significant improvement in trait hope. The amount of change in state hope was significantly associated with baseline levels of hope, with less hopeful individuals more likely to show larger gains (p= 0.004). Patients in the MSS group (n= 7) showed a significant improvement in hope (4.43 points; p= 0.04), after adjusting for baseline hope levels, whereas neither of the other treatment groups had statistically significant change (p= 0.47 for MSS-SOS and p= 0.051 for the AC group).
Conclusion:
This pilot study is the first of its kind to describe state and trait hope in IHD patients, while more specifically examining hope levels in hopeless IHD patients who received an emotional support intervention. Hopeless IHD patients receiving emotional support from a nurse had significant improvement in state hope, as compared to patients receiving support from both a nurse and significant other or those in an attention control group. An emotional support intervention from a nurse may be effective in improving a hopeless patient’s positive motivational state. The significant findings in this small sample provide the scientific premise for a larger trial. The Global Hearts initiative from the World Health Organization and its partners calls to reduce the global threat of cardiovascular disease, including IHD (World Health Organization, 2016). Because hopelessness is predictive of decreased survival (Freedland et al., 2009) and increased adverse clinical events (Pederson et al., 2007), further examination of interventions to promote hope in IHD patients is needed globally.
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