Self-Care Confidence Mediates the Relationship Between Cognition and Self-Care Behaviors in Adults With Heart Failure

Background: Confidence in the ability to perform self-care is a powerful predictor of behavior. Little is known about factors associated with HF self-care confidence. We hypothesized that subtle levels of cognitive impairment decrease self-care confidence and thereby impair HF self-care. The aim was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. Methods: A descriptive study was conducted with a convenience sample of 628 patients with a confirmed diagnosis of chronic HF. Participants were selected from 24 cardiovascular centers across Italy if they were >18 years old and stable for the past 3 months. Self-care maintenance, management and confidence were measured with the Self-Care of Heart Failure Index (SCHFI v.6.2) (0-100, higher score=better self-care). Cognition was measured with the Mini Mental State Examination (MMSE, 0-30, higher score=better cognition). Structural equation modeling was used to test the mediating role of self-care confidence in the relationship between cognition and self-care maintenance and management. Results: Participants were mean age 73 years (SD 11), 58% male, 77% NYHA class II/III, mean ejection fraction 43%. Self-care was poor (mean score range 53 to 55). Mean MMSE was 23 (SD 6.3) or slightly impaired. The specified model fit adequately: {chi}2(1) = 1.825, p=.18; CFI=1.00; TLI=.99; RMSEA=.036 (CI=.000 - .120), p=.47; SRMR=.012. Self-care confidence totally mediated the relationship between MMSE and self-care maintenance and partially mediated the relationship between MMSE and self-care management even though management was explained mostly by confidence and not MMSE (Figure). Conclusion: One mechanism by which cognition influences self-care appears to be through its effect on self-care confidence. Interventions aimed at improving self-care confidence may be useful in improving HF self-care behaviors in patients with mild cognitive impairment.