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Self-Care confidence predicts self-care management and maintenance in patients with heart failure

Session Moderated poster session - Heart Failure

Speaker Assistant Professor Angela Massouh

Congress : EuroHeartCare 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure - Treatment
  • Session type : Moderated Posters
  • FP Number : 213

Authors : A Massouh (Beirut,LB), P Cook (Denver,US), H Huijer (Beirut,LB), H Skouri (Beirut,LB), P Meek (Denver,US)

Authors:
A Massouh1 , P Cook2 , H Huijer1 , H Skouri3 , P Meek2 , 1American University of Beirut AUB, School of Nursing - Beirut - Lebanon , 2University of Colorado Denver, College of Nursing - Denver - United States of America , 3American University of Beirut Medical Center, Cardiology - Beirut - Lebanon ,

Citation:

Background: Self-care is recognized as a universal approach for improving outcomes of heart failure (HF). Literature is in consensus on the influence of self-care confidence on how decisions are made and self-care behaviors are done by HF patients. It is thus imperative to examine whether it explains the influence of other determinants of self-care in patients with HF. 

Purpose: The purpose of this analysis was to examine whether self-care confidence, as a mediator, explained the associations of social support and HF-specific knowledge with self-care. 

Methods: This is a cross-sectional, correlational study using a sample of 100 HF patients (mean age 67.59 years; 76% males). Self-care was measured using the Arabic version of the Self-Care of HF Index. While social support was measured using the ENRICHD Social Support Instrument, and HF-specific knowledge using the Dutch HF Knowledge scale. We performed regression analyses to examine associations between perceived support and HF-knowledge and self-care maintenance and management. Mediation analysis was done using the Baron and Kenny method complemented by a Beta percentage change of more than or equal to 20% and Sobel Z test and bootstrapping using 1000 replications of the original sample and a 95% confidence limit. 

Results: Self-care in this sample was suboptimal. Self-care confidence mediated the association between social support and self-care maintenance (direct path reduced from ß= 0.300 to 0.185; percent change: 38.3%). This was also supported by a Sobel test showing a nonzero indirect effect (z = 2.62, p = 0.008), and a 95% bootstrap confidence interval for the indirect effect not including zero (95% CI 0.141 to 0.401).

Self-care confidence also mediated the association between HF-knowledge and self-care maintenance (direct path reduced from Beta= 2.569 to 1.694, p= 0.011, percent change in Beta is 34.1%). This was also supported by a Sobel test showing a nonzero indirect effect (z = 3.007, p = .002) and a 95% bootstrap confidence interval for the indirect effect not including zero (95% CI 0.117 to 0.379).

Finally, self-care confidence also mediated the association between HF-knowledge and self-care management (direct path reduced from Beta= -0.307 to -0.144, p= 0.214, percent change in Beta is 53.1%). This was also supported by a Sobel test showing a nonzero indirect effect (z = -2.78, p = .0054) and a 95% bootstrap confidence interval for the indirect effect not including zero (95% CI -0. 068 to -0.019).

Conclusion: Self-care confidence explains the influence of social support and knowledge on self-care. Therefore, efforts to support self-care confidence may have a larger effect on self-care than targeting individual determinants alone. Improving self-care confidence may be a key target for interventions to improve disease management and self-care behaviors in HF patients.

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It is now only available year-round to ACNAP Silver Members, Fellows of the ESC and Young combined Members



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