| Objectives:The aims of this study were to investigate the level of self-regulatory fatigue in patients with chronic heart failure,to explore the influencing factors of patients’self-regulatory fatigue based on the biopsychosocial holistic model of cardiovascular health,and to construct network model,in order to provide a basis for developing precise interventions to reduce patients’selfregulatory fatigue and improve their health outcomes.Methods:This is a cross-sectional study using a convenient sampling method.From December 2021 to December 2022,240 patients with chronic heart failure were investigated in the cardiology departments of three tertiary grade-A hospitals in Jinan,Shandong Province.Data were collected with the self-designed general information questionnaire,Self-regulatory Fatigue Scale,Symptom Status Questionnaire-Heart Failure,Chronic Disease Self-efficacy Scale,Selfperceived Burden Scale,Fear of Progression Questionnaire-Short Form,Social Support Rating Scale,and Family APGAR Index.SPSS 27.0 and R 4.2.2 were used to analyze the data,including descriptive analysis,comparison of differences,correlation analysis,regression analysis,and network analysis.Results:1.The scores for self-regulatory fatigue and its dimensions in patients with chronic heart failureThe total mean score for self-regulatory fatigue in patients with chronic heart failure was(39.44±6.33),of which the mean score for cognitive control fatigue dimension was(15.58±2.71),the mean score for emotional control fatigue dimension was(12.08±2.36),and the mean score for behavioral control fatigue dimension was(11.78±2.58).The total score for selfregulatory fatigue and the scores for three dimensions were higher than the domestic norm.2.Relationships between general data characteristics and self-regulatory fatigue and its dimensions in patients with chronic heart failurePatients with chronic heart failure with monthly income<3000 and non-first visit had higher scores for self-regulatory fatigue,cognitive control fatigue dimension,and emotional control fatigue dimension than those with monthly income≥ 3000 and first visit(all P<0.05).Patients with chronic heart failure who were female,had an education level of junior high school or less,unemployed,and had a disease duration≥ 6 months had higher scores for the cognitive control fatigue dimension than those who were male,had an education level of high school or high,working or farming,and had a disease duration<6 months(all P<0.05).Patients with chronic heart failure aged<60 years,working or farming had higher scores for the emotional control fatigue dimension and behavioral control fatigue dimension than those aged≥60 years and retired(both P<0.05).3.Correlations between physiological,psychological,and social factors and selfregulatory fatigue and its dimensions in patients with chronic heart failurePhysiological factors:the mean score for physical symptoms in patients with chronic heart failure was(22.39 ± 11.79),which was positively correlated with the total score for selfregulatory fatigue(r=0.332,P<0.01),the score for cognitive control fatigue dimension(r=0.378,P<0.01),the score for emotional control fatigue dimension(r=0.209,P<0.01)and the score for behavioral control fatigue dimension(r=0.225,P<0.01).Psychological factors:the mean score for self-efficacy in patients with chronic heart failure was(6.45 ± 1.38),which was negatively correlated with the total score for self-regulatory fatigue(r=-0.488,P<0.01),the score for cognitive control fatigue dimension(r=-0.448,P<0.01),the score for emotional control fatigue dimension(r=-0.476,P<0.01),and the score for behavioral control fatigue dimension(r=-0.290,P<0.01).The mean score for perceived burden was(21.20±6.44),and the mean score for fear of disease progression was(25.37±7.24)in patients with chronic heart failure.The scores for perceived burden and fear of disease progression were positively correlated with the total score for self-regulatory fatigue(r=0.418,P<0.01;r=0.477,P<0.01),the score for cognitive control fatigue dimension(r=0.327,P<0.01;r=0.292,P<0.01),the score for emotional control fatigue dimension(r=0.335,P<0.01;r=0.419,P<0.01),and the score for behavioral control fatigue dimension(r=0.377,P<0.01;r=0.482,P<0.01).Social factors:the mean score for social support was(44.52±5.16),and the mean score for family care was(8.31± 1.42)in patients with chronic heart failure.The scores for social support and family care were negatively correlated with the total score for self-regulatory fatigue(r=-0.403,P<0.01;r=-0.375,P<0.01),the score for cognitive control fatigue dimension(r=-0.430,P<0.01;r=-0.289,P<0.01),the score for emotional control fatigue dimension(r=-0.280,P<0.01;r=-0.289,P<0.01),and the score for behavioral control fatigue dimension(r=-0.281,P<0.01;r=-0.353,P<0.01).4.Multiple linear regression analysis of self-regulatory fatigue and its dimensions in patients with chronic heart failureThe factors associated with the total score for self-regulatory fatigue in patients with chronic heart failure were physical symptoms(β=0.181,P<0.001),self-efficacy(β=-0.306,P<0.001),perceived burden(β=0.138,P=0.020),fear of disease progression(β=0.280,P<0.001),social support(β=-0.188,P<0.001),and family care(β=-0.178,P=0.001),and the six variables accounted for 53.3%of the variation in self-regulatory fatigue(adjusted R2=0.533).The factors associated with the score for cognitive control fatigue dimension in patients with chronic heart failure were physical symptoms(β=0.228,P<0.001),self-efficacy(β=0.263,P<0.001),perceived burden(β=0.149,P=0.021),and social support(β=-0.281,P<0.001),and the four variables accounted for 45.3%of the variation in cognitive control fatigue(adjusted R2=0.453).The factors associated with the score for emotional control fatigue dimension in patients with chronic heart failure were self-efficacy(β=0.370,P<0.001),fear of disease progression(β=0.196,P=0.008),and family care(β=-0.122,P=0.049),and the three variables accounted for 38.8%of the variation in emotion control fatigue(adjusted R2=0.388).The factors associated with the score for behavioral control fatigue dimension in patients with chronic heart failure were physical symptoms(β=0.136,P=0.011),self-efficacy(β=0.159,P=0.005),fear of disease progression(β=0.303,P<0.001),and family care(β=0.203,P=0.001),and the four variables accounted for 38.3%of the variation in behavioral control fatigue(adjusted R2=0.383).5.A network model of self-regulatory fatigue dimensions and its influencing factors in patients with chronic heart failureA network model was constructed using the dimensions of self-regulatory fatigue(cognitive control fatigue,emotional control fatigue,and behavioral control fatigue)and variables that were statistically significant for multiple linear regression analysis.The results showed that physical symptoms(0.24),self-efficacy(-0.22),perceived burden(0.11),and social support(-0.25)were directly associated with cognitive control fatigue;self-efficacy(-0.24)and fear of disease progression(0.09)were directly associated with emotional control fatigue;fear of disease progression(0.21)and family caregiving(-0.17)were directly associated with behavioral control fatigue.Cognitive control fatigue was the core node of this network because of its high strength,closeness and betweenness.In addition,the model’s CS=0.67(≥0.50),indicating that the model had sufficient stability.Conclusions:1.The level of self-regulatory fatigue in patients with chronic heart failure is high.It suggests that health care workers should evaluate patients’ self-regulatory fatigue in time and take interventions.2.The positive influencing factors of self-regulatory fatigue in patients with chronic heart failure include physical symptoms,perceived burden and fear of disease progression,while the negative influencing factors include self-efficacy,social support and family care.It is suggested that health care workers can use the above factors as entry points and take appropriate interventions to alleviate patients’ self-regulatory fatigue.3.The associations vary between different dimensions of self-regulatory fatigue and influencing factors in patients with chronic heart failure,among which the factors associated with the cognitive control fatigue dimension can be key targets for intervention.This provides a basis for health care workers to develop precise interventions. |
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