Introduction: Essential elements of heart failure (HF) self-care include engagement in daily behaviors that maintain physical stability (self-care maintenance) and recognition of symptoms with a timely response (self-care management). Comorbidity decreases self-efficacy or confidence in the ability to perform self-care which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization and poorer quality of life (QOL). Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and QOL remains unclear. Hypotheses: 1) Comorbidity and self-efficacy are determinants of self-care maintenance and management which in turn are determinants of hospitalization and QOL; 2) Comorbidity moderates the relationship between self-efficacy and self-care maintenance and management. Methods: An existing dataset of 628 symptomatic, older (mean age = 73, SD = 11) male (58%) Italian HF patients was analyzed using structural equation modeling and simple slope analysis. Measures used were the Charlson Comorbidity Index; Self-Care of Heart Failure Index (V6.2) for self-efficacy, self-care maintenance and self-care management; medical record review for hospitalization; and Minnesota Living with Heart Failure Questionnaire for QOL. Results: In the model higher comorbidity was associated with lower self-care management but not maintenance. Higher self-efficacy was associated with both higher self-care maintenance and management. Higher self-care maintenance was associated with fewer hospitalizations and better overall QOL. In the moderation analysis comorbidity moderated the relationship between self-efficacy and self-care maintenance. Higher comorbidity weakened the strength of the relationship between self-efficacy and self-care maintenance in post-hoc simple slopes analysis. Conclusions: The strength of the relationship between self-efficacy and self-care maintenance was a function of comorbidity. Self-care maintenance was associated with hospitalization and QOL. Therefore, tailoring interventions to improve self-efficacy at different levels of comorbidity may be key to impacting hospitalization and QOL in HF.
Buck, H., Dickson, V., Fida, R., Riegel, B., D’Agostino, F., Alvaro, R., et al. (2015). Abstract 10274: It’s Complicated: Comorbidity, Self-efficacy, Self-care When Hospitalization and Quality of Life are Outcomes in Heart Failure. CIRCULATION.
Abstract 10274: It’s Complicated: Comorbidity, Self-efficacy, Self-care When Hospitalization and Quality of Life are Outcomes in Heart Failure
ALVARO, ROSARIA;VELLONE, ERCOLE
2015-01-01
Abstract
Introduction: Essential elements of heart failure (HF) self-care include engagement in daily behaviors that maintain physical stability (self-care maintenance) and recognition of symptoms with a timely response (self-care management). Comorbidity decreases self-efficacy or confidence in the ability to perform self-care which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization and poorer quality of life (QOL). Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and QOL remains unclear. Hypotheses: 1) Comorbidity and self-efficacy are determinants of self-care maintenance and management which in turn are determinants of hospitalization and QOL; 2) Comorbidity moderates the relationship between self-efficacy and self-care maintenance and management. Methods: An existing dataset of 628 symptomatic, older (mean age = 73, SD = 11) male (58%) Italian HF patients was analyzed using structural equation modeling and simple slope analysis. Measures used were the Charlson Comorbidity Index; Self-Care of Heart Failure Index (V6.2) for self-efficacy, self-care maintenance and self-care management; medical record review for hospitalization; and Minnesota Living with Heart Failure Questionnaire for QOL. Results: In the model higher comorbidity was associated with lower self-care management but not maintenance. Higher self-efficacy was associated with both higher self-care maintenance and management. Higher self-care maintenance was associated with fewer hospitalizations and better overall QOL. In the moderation analysis comorbidity moderated the relationship between self-efficacy and self-care maintenance. Higher comorbidity weakened the strength of the relationship between self-efficacy and self-care maintenance in post-hoc simple slopes analysis. Conclusions: The strength of the relationship between self-efficacy and self-care maintenance was a function of comorbidity. Self-care maintenance was associated with hospitalization and QOL. Therefore, tailoring interventions to improve self-efficacy at different levels of comorbidity may be key to impacting hospitalization and QOL in HF.File | Dimensione | Formato | |
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