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Effects of time perspective and executive function on self-care in patients with heart failure: a cross-sectional study
Time perspective refers to one’s consideration about future consequences of current behaviours. Executive function refers to a set of cognitive processes mainly working memory, inhibition and mental flexibility that allows for higher order thinking. Both has been shown to change behavioural intentions and actual behaviours through self-regulation but has yet to be explored in the heart failure self-care context. Improving self-care such as sodium restriction and increasing exercise could improve clinical outcomes, decrease rehospitalisation and enhance quality of life.
To examine the effects of time perspective and executive function on heart failure patient’s self-care.
Cross-sectional study. 147 heart failure patients from a tertiary hospital completed questionnaire and cognitive measures of self-care, time perspective, intention and executive function. Multiple regressions, mediation and moderation analyses was conducted using the PROCESS macro for SPSS were conducted.
Self-care level was suboptimal (87.1% below cut-off score). Non-adherence rates were high for medication adherence (10.8%), physical activity (general: 55.8%; at least 30 minutes: 68.7%), weight monitoring (76.2%) and sodium restriction (at home: 46.9%; outside: 71.4%). Self-care was associated with time perspective (r =.362), executive function (r=.174) and intention (r =.184). Time perspective mediated the self-care intention-behaviour relationship, explaining 62.0% of the total effect and was not moderated by executive function. The indirect effect of intention on self-care through time perspective was 1.205 with a bootstrapped 95% confidence interval (0.532 , 2.145). There were differences in time perspective (mean=4.538, standard deviation (SD)=.834; t=3.109, p=.002 CI:.158,.711) and executive function (mean=5.47, SD=1.60; t=3.012, p=.003; CI:.251,1.208) for patients below and above 61 years old. Majority of the patients were male (77.6%), Chinese (70.1%), married (65.3%), have at most secondary school education (41.5%), family income less than SG$ 3000 (65.3%), employed full-time (41.5%), stays with someone (87.1%) and most importantly, rely on themselves as caregiver (61.9%) (Table 1). The median left ventricular ejection fraction (LVEF) was 27%, majority were of New York Heart Association class II (55.1%) and has at least 3 comorbidities estimated using the Charlson comorbidity Index score.
Clinicians and counselors could motivate patients’ self-care by enhancing future-oriented time perspective tailored according to age. As executive function may be difficult to improve in older patients, executive function demands could be outsourced to visual reminders or other personalized systems like planners. Further research could be done on health message framing and personality types to develop more effective interventions to improve self-care habits.