The Actor-partner Effects Of Associated Factors On Quality Of Life In Patients With Chronic Heart Failure And Family Caregivers

ObjectivesThe objective of this study was to explore the actor-partner effects of biological,psychological,and social factors on quality of life(including physical and mental quality of life)in patients with chronic heart failure(CHF)and their family caregivers based on the biopsychosocial holistic model of cardiovascular health as well as the Actor-Partner Interdependence Model.It was expected to provide reference for designing intervention strategies and improving their quality of life(QOL).MethodsA cross-sectional design was used in this study.Convenience sampling was conducted to recruit 269 dyads of hospitalized patients with CHF and their family caregivers from two hospitals in Shandong province between November 2017 and August 2018.The data were collected with the 12-item Short Form Health Survey,the Fatigue Scale,the Pittsburgh Sleep Quality Index,the Herth Hope Index,the Self-esteem Scale,the Family APGAR Index,and a self-designed general information questionnaire.SPSS 22.0 and HLM 6.08 were used to analyze the data.Results1.The mean scores for physical and mental QOL in patients with CHF were 50.00±18.16 and 49.99±9.45,respectively;the mean scores for physical and mental QOL among family caregivers were 49.99±9.88 and 50.00±10.04,respectively.There were no significant differences in scores for both physical and mental QOL between patients and caregivers(all P>0.05).2.Relationships between general characteristics and QOL in patients with CHF and their family caregivers(1)Age was negatively correlated with the score for physical QOL among CHF patients,and patients who were unemployed,had a higher NYHA class,with disease duration?6 months,hospitalized?3 times due to heart failure scored lower on physical QOL.BMI was positively correlated with the score for mental QOL among CHF patients,and patients who had NYHA class IV,with disease duration?6 months,hospitalized?3 times due to heart failure scored lower on mental QOL.(2)Both age and BMI were negatively correlated with the score for physical QOL among family caregivers,and caregivers who were female,educated below primary school,retired or doing freelance work,had monthly incomes<1000 RMB,partnered with patients,taking care of patients ? 6 months scored lower on physical QOL.Family caregivers who were educated below primary school scored lower on mental QOL.3.Relationships between biological factors,psychological factors,social factors and QOL in patients with CHF and their family caregivers(1)CHF patients' physical and mental QOL were positively correlated with family caregivers' physical and mental QO(r = 0.133,P<0.05;r-0.160,P<0.01).Scores for hope(r = 0.315,P<0.01),self-esteem(r = 0.318,P<0.01),and family APGAR(r = 0.436,P<0.01)in patients with CHF were positively correlated with those of family caregivers.(2)There were 62.1%of the CHF patients and 33.1%of the family caregivers had the symptom of fatigue,and there were 61.7%of the CHF patients and 29.7%of the family caregivers had a poor sleep quality.CHF patients and family caregivers who had the symptom of fatigue and had a poor sleep quality scored lower on both physical and mental QOL than those who had no symptom of fatigue and had no sleep problem(all P<0.01).(3)Scores for hope(r = 0.290,P<0.01;r = 0.442,P<0.01),self-esteem(r =0.178,P<0.01;r = 0.392,P<0.01)and family APGAR(r = 0.146,P<0.05;r =0.177,P<0.01)were positively correlated with scores for both physical and mental QOL among CHF patients.Scores for self-esteem(r = 0.184,P<0.01;r=0.351,P<0.01)and family APGAR(r = 0.179,P<0.01;r = 0.197,P<0.01)were positively correlated with scores for both physical and mental QOL among family caregivers.In addition,family caregivers'hope score was also positively correlated with their own mental QOL(r = 0.423,P<0.01).(4)Scores for hope(r = 0.167,P<0.01)and self-esteem(r = 0.121,P<0.05)in patients with CHF were positively correlated with the score for mental QOL among family caregivers.Scores for hope(r = 0.269,P<0.01),self-esteem(r = 0.200,P<0.01)and family APGAR(r = 0.121,P<0.05)among family caregivers were positively correlated with the score for mental QOL among CHF patients.4.Multiple regression of QOL in patients with CHF and family caregivers(1)Factors associated with the physical QOL among CHF patients were unemployed,NYHA class ?/?/?,sleep quality and hope.These variables explained 22.1%of the variance in physical QOL.Factors associated with the mental QOL among CHF patients were BMI,fatigue,hope and self-esteem.These variables explained 34.4%of the variance in mental QOL.(2)Factors associated with the physical QOL among family caregivers were age,retirement or freelance work,BMI,fatigue and sleep quality.These variables explained 25.5%of the variance in physical QOL.Factors associated with the mental QOL among family caregivers were fatigue,sleep quality and hope.These variables explained 25.8%of the variance in mental QOL.5.The actor-partner effects of associated factors on QOL in patients with CHF and their family caregivers(1)There were actor effects of fatigue on both physical(B =-6.625,P<0.01)and mental(B =-12.288,P<0.01)QOL for CHF patients.Moreover,there were actor effects of fatigue on both physical(B =-12.601,P<0.01)and mental(B =-10.278,P<0.01)QOL for family caregivers.(2)There were actor effects of sleep quality on both physical(B =-7.144,P<0.01)and mental(B =-5.125,P<0.01)QOL for CHF patients.Moreover,sleep quality of patients also had a significant partner effect on mental QOL of caregivers(B =-2.936,P<0.05).There were actor effects of sleep quality on both physical(B=-7.250,P<0.01)and mental(B =-6.384,P<0.01)QOL for family caregivers.(3)There were actor effects of hope on both physical(B=1.098,P<0.01)and mental(B= 1.154,P<0.01)QOL for CHF patients.There was an actor effect of hope on mental QOL for family caregivers(B = 0.915,P<0.01).Moreover,caregivers'hope had a significant partner effect on mental QOL of patients(B = 0.805,P<0.05).(4)There was an actor effect of self-esteem on mental QOL for CHF patients(B=0.773,P<0.05).(5)There was an actor effect of family APGAR on physical QOL for family caregivers(B 1.221,P<0.05).Conclusions1.The QOL in patients with CHF and family caregiver are positively correlated with each other,and both of them need to be improved.2.Factors influencing the physical QOL among CHF patients were employment status,NYHA,sleep quality and hope;Factors influencing the mental QOL among CHF patients were BMI,fatigue,hope and self-esteem.3.Factors influencing the physical QOL among family caregivers were age,employment status,BMI,fatigue and sleep quality;Factors influencing the mental QOL among family caregivers were fatigue,sleep quality and hope.4.Sleep quality and hope of CHF patients and their family caregivers can influence their own QOL,meanwhile,patients' sleep quality and caregivers'hope can also influence mental QOL for each other;CHF patients'or family caregivers'fatigue,self-esteem and family APGAR only influence their own QOL.5.Clinical healthcare providers should include family caregivers in the nursing plan of patients,and carry out family-oriented nursing intervention from physiological,psychological and social aspects,especially focusing on patients' sleep quality and caregivers'hope,so as to improve the quality of life in patients with CHF and their family caregivers.