Predictive Model Of Self-care Behaviors For Patients With Chronic Heart Failure

Objectives To describe the self-care behaviors(refering to self-care maintenance and management)for patients with chronic heart failure and explore the influencing factors of self-care behaviors among CHF patients and the path relationship between these factors.and build a influencing factors model of self-care behaviors for CHF patients when developing the tailored interventions for patients with CHF to enhance their self-care behaviors.Methods A cross-sectional questionnaire survey was conducted from February 2019 to December 2019.A convenience sampling with a total of 310 patients with CHF was recruited at the cardiac wards of tertiary hospital in anhui province.General information questionnaire,Self-Care of Heart Failure Index(SCHFI v6.2),Hospital Anxiety and Depression Scale(HADS),Type D Personality scale-14(DS-14),Health Literacy Scale for Patients with Chronic Diseases,Montreal Cognitive Assessment(Mo CA),Social Support Rating Scale(SSRS),The Charlson Comorbidity Index(CCI),Heart Failure Knowledge Test(HFKT),the 36-item Medical Outcomes Study Short Form(SF36-PF)were used to investigate CHF patients.Epi Data3.1 was used for data entry,Data were analyzed using SPSS23.0 and Amos17.0.Results(1)The score for self-care maintenance was(37.06±10.12)and for self-care management was(38.95±17.25).A score of greater or equal to 70 indicates adequate self-care behaviors in CHF patients,there were 306 patients score less than 70(98.71%)for self-care maintenance,and 293 patients score less than 70(94.50%)for self-care management.The items with the top three scores of self-care maintenance were forgetting to take medication,a low-salt diet and checking for ankle edema,The items with the top three scores of self-care management were reducing salt in the diet,consulting a doctor or nurse and how long it took to identify it as a symptom of heart failure.(2)CHF patients who are married,live in urban areas,have medical insurance,have higher education and income level,and disease duration >6 months had a higher self-care maintenance score.Patients with CHF who have medical insurance,higher education and income level,and course of disease > 6 months had higher self-care management scores.(3)The score for self-care maintenance and management of CHF patients with cognitive function ? 24 were higher than those with cognitive function <24.Health literacy,social support,heart failure knowledge,physical functioning,self-care confidence were positively correlated with self-care maintenance,while anxiety and depression were negatively correlated with self-care maintenance.Health literacy,social support,heart failure knowledge,self-care confidence were positively correlated with self-care management,while depression was negatively correlated with self-care management.(4)The results of the structural equation model showed that the total effect of health literacy on self-care maintenance was the largest(total effect was0.299,of which the direct effect was 0.17 and the indirect effect was 0.129).Self-care confidence had the largest total effect on self-care management(total effect was 0.445,of which the direct effect was 0.368 and the indirect effect was 0.077).Health literacy and social support had direct effects on self-care maintenance were 0.170 and 0.231 respectively.Self-care confidence,body function and knowledge had direct effects on self-care management,which were 0.368?-0.157 and 0.311,respectively.Depression,cognition,health literacy,type D personality had indirect effects on self-care maintenance,with indirect effects were-0.175,0.217,0.129 and-0.028,respectively.Depression,cognition,health literacy,self-care confidence,physical functioning,social support,comorbidity and type D personality had indirect effects on self-care management,with indirect effects were-0.219,0.308,0.356,0.077,-0.063,0.073,0.034and-0.047,respectively.These factors could account for 13.4% variation in self-care maintenance and 48.8% variation in self-care management.Conclusion The self-care behaviors in patients with CHF is not adequate.The modelsuggests that health literacy and self-care confidence are important influencing factors of self-care behaviors.(1)Variables with positive direct effects on self-care maintenance included health literacy and social support,variables with positive indirect effects included cognition and health literacy,and variables with negative indirect effects included depression and type D personality.(2)Variables with positive direct effects on self-care management included knowledge and self-care confidence,and variable with negative direct effect was physical functioning,and variables with positive indirect effects included comorbidity,cognition,health literacy,self-care confidence,social support,and variables with negative indirect effects included depression,physical functioning,and type D personality.Clinical researchers can combine the pathway relationship between variables provided by this model to formulate corresponding intervention measures to provide theoretical basis for improving self-care behaviors and physical and mental health of patients with CHF.