Factors Influencing Self-care Agency Of Inpatients With Chronic Heart Failure: A Cross-sectional Study

Objective:1. To investigate self-care agency (SCA) of inpatients with chronic heart failure (CHF), as well as the level of general self-efficacy, self-efficacy for managing chronic disease, perceived social support, and the prevalence of anxiety and depression.2. To analyze influencing factors that affecting SCA of inpatients with CHF.Methods:A cross-sectional study was used.159 inpatients with CHF were recruited from cardiology department of a tertiary-care hospital in Shandong Province during November 2009 to July 2010. Data on social demography, illness features, general self-efficacy, self-efficacy for managing chronic disease, perceived social support, anxiety and depression during hospitalization, and general self-care agency of patients with CHF was collected by relevant questionnaires, processed and analyzed by SPSS 11.5.Results:1. Mean score of SCA of inpatients with CHF was 52.43±15.53, of which the demension of knowledge upon heart failure and self-care was 6.86±8.72, of abilities for engaging in self-care was 28.06±5.99, and of abilities for self-health care was 17.52±6.93.2. SCA of inpatients with CHF was influenced both by the characteristics of social demography and the illness features. Those who were male, with middle school educational level or above, married, urban residents, engaged in brainwork or non-farming manual labor, with per capita income of family>￥1000 monthly, had the urban residents basic medical insurance or free medical care trended to demonstrate a higher score of SCA, compared with those who were female, with primary school educational level or below, widowed or divorced, rural residents, engaged in farming, with per capita income of family<￥1000 monthly, joined in the rural cooperative care system. Those who had a cardiac history within half a year, hospital stays<6 days, and denied getting the health education usually had a lower score, compared with those who had a cardiac history more than half a year, hospital stays>15 days, and confirmed getting the health education.3. The score of general self-efficacy with patients of CHF was 2.61±0.65, which positively correlated with general self-care agency (r=0.196, P<0.05). The score of self-efficacy for managing chronic disease was 7.74±1.61, which had positive correlation with abilities for engaging in self-care (rs=0.249,P<0.01). The score of perceived social support was 59.81±13.60, which also positively correlated with general self-care agency (rs=0.263, P<0.01).30.19% patients with anxiety while 22.64% patients with depression, and the scores for anxiety and depression were separately 6.04±4.74 and 4.64±4.94, both of which had negative correlation with abilities for engaging in self-care (rs=-0.338, P<0.01; rs=-0.436, P<0.01).4. Multiple regression was used to analyze factors that influencing SCA. Educational level, place of residence, whether confirmed getting the health education or not, and depression were influencing factors of general self-care agency in patients with CHF (R2 adj=0.266).Educational level,per capita income of family, times of hospitalization, and acknowledgement for the diagnosis of heart failure were factors influencing knowledge about the disease (R2adj=0.306). Factors influencing abilities for engaging in self-care including:depression, general self-efficacy, perceived social support from significant other, and gender (R2adj=0.269). And influencing factors of abilities for self-health care including:educational level, per capita income of family, gender, whether confirmed getting the health education or not, and primary caregivers (R2adj= 0.236).Conclusion:1. The self-care agency of inpatients with CHF was at a low level, in particular, knowledge for heart failure and self-care was extremely poor, indicating that health education upon self-care, which is an important way to help patients acquire the knowledge and skills for self-care agency, is not sufficient and needed to be strengthened.2. There were a variety of factors might influencing SCA of patients with CHF. After excluding the confounding factors, gender, educational level, place of residence, economic status, times of hospitalization, acknowledgement for the diagnosis of heart failure, confirmed getting the health education or not, primary caregivers, depression, general self-efficacy, perceived social support from significant other were found as influencing factors on SCA. Therefore, with the intention of promoting patients' abilities for engaging in self-care and improving their self-care agency, nurses should put different emphases on patients with diverse traits when deliver health education, implement optimum nursing interventions which could relieve patients' depressive mood, give comfort and support, and enhance their self-efficacy.