| ObjectiveIn order to enhance chronic heart failure patients’self-care adherence and provide a reference to improve their prognosis and quality of life, we investigated the self-care adherence status of heart failure patients, and explored its associated factors based on the IMB (Information-Motivation-Behavioral skill) theoretical model.MethodsA total of 210 patients with chronic heart failure participated in the cross-sectional study from February to August,2014. The patients completed Self-Care of Heart Failure Index (SCHFI) Chinese version, Revised Illness Perception Questionnaire (IPQ-R), Perceived Social Support Scale (PSSS), HF Self-care Knowledge Questionnaire, Mini-Mental State Examination (MMSE) and self-designed demographic questionnaire. SPSS 16.0 was used to analyze the data.Results1. The lowest score of self-care maintenance was 10.0. The highest score was 89.99. The average score was (53.66±14.55). It was at a low level. The self-care maintenance was adequate (score≥70) in 27 (2.9%) chronic heart failure patients.2. Chronic heart failure patients who were living in rural, had lower educational level, with less family income and 0-2 comorbid conditions’younger employed married males had significantly lower self-care maintenance scores than those who were living in city, had higher educational level, with more family income and 3-5 comorbid conditions’elder retired single females (P<0.05).3. The mean score of the HF self-care knowledge was (6.92±1.45). Significant positive correlations were found between HF self-care knowledge score and scores of self-care maintenance, self-care management and self-care confidence (r=0.383,0.352, 0.287, P<0.01).The total score of perceived social support was (64.77±6.19). Subscale scores were (26.07±2.35) for family, (17.14±3.54) for friends, (21.57±2.47) for significant others. A similar pattern of significant positive correlations were also found between social support total score, subscales of family, significant others and self-care maintenance (r= 0.235,0.289,0.226; P<0.05), except the friends social support subscale (P>0.05). Total score and subscale scores of social support were also positively correlated with self care management and self care confidence scores (r=0.335,0.240,0.248,0.255; P<0.01 and r=0.352,0.197,0.261,0.321; P<0.01)The average scores of illness perception dimensions were timeline-acute/chronic (18.50±5.97), timeline cyclical (13.00±3.84), consequences (18.57±4.17), personal control (18.90±3.28), treatment control (19.36±1.97),illness coherence (13.00±3.84), emotional representation (17.86±5.40). Timeline-acute/chronic and consequences scores positively correlated with self-care management score (r=0.151,0.145; P <0.05). The score of illness coherence was correlated negatively with self-care maintenance, self-care management and self-care confidence scores (r=-0.257,-0.233,-0.182; P<0.01). Emotional representation score and self-care confidence correlated negatively (r=-0.146,P<0.05).The self care management score was (57.07±12.45). The score of self care confidence was (56.55±15.15). Both positively related to self care maintenance score (r=0.411,r=0.448;P<0.01).4. Multiple regression analysis was performed. The associated factors of self-care adherence were HF self-care knowledge, social support from family, self-care management, self-care confidence, age, gender and family income. Seven variables explained 47.1% of the variance in self-care maintenance of heart failure patients (Adjusted R2=0.471).Meanwhile, Baron and Kenny analyses indicated that self-care management partly mediated the relationship between HF self care knowledge, social support from family and self-care maintenance (P<0.05). And it completely mediated the relationship between personal control and self-care maintenance (P<0.05 to P<0.05). In addition, self-care confidence also partly mediated the relationship between HF self care knowledge and self-care maintenance (P<0.05).Conclusions1. The self-care adherence of patients with chronic heart failure is poor. It needs to be improved, especially for those who were living in rural, had lower educational level, with less family income and 0～2 comorbid conditions’ younger employed married males.2. Findings revealed that HF self-care knowledge, social support from family, self-care management, self-care confidence, age, gender and family income associated positively with patients’ self-care adherence, even after multiple adjustments.3. Additionally, HF self care knowledge, social support from family and personal control had direct or indirect effects (by acting on self-care management) on self-care adherence. And HF self care knowledge positively associated with self-care adherence directly or indirectly by acting on self-care confidence.4. Clinical health providers may take measures based on three aspects such as knowledge, motivation and behavioral skills to improve patients’ self-care adherence. |
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