| Objective The objects of this study was to investigate the status of symptom burden,self-efficacy, social support, quality of life in patients with chronic heart failure, to analyze influences of social-demographic characteristics on symptom burden,self-efficacy, social support, quality of life, to explore the relationships among symptom burden, self-efficacy, social support, quality of life, to build up structural equation model of the 4 variables, to identify the effects of pathway among symptom burden,self-efficacy, social support, quality of life, then provide theoretical reasons and data reference on how to set up intervention measurements, to improve symptom burden and optimize quality of life in patients with chronic heart failure.Methods Using the method of convenience sampling, 300 patients with chronic heart failure from the first affiliated hospital of Bengbu Medical College, in Anhui Province,were recruited from January 2015 to August 2015, filled out the self-made social-demographic characteristics, the Memorial Symptom Assessment Scale-Heart Failure, the Social Support Rating Scale, the Self-Efficacy for Managing Chronic Disease 6-Item Scale, the Minnesota Living with Heart Failure Questionnaire. The SPSS 18.0 statistical analysis package and Amos 21.0 was used to analyze the data. The statistics method included descriptive statistics, independent t-tests and one-way analysis of variance, multifactor analysis. Pearson product-moment correlation analysis was used to identify relationships among different variables. Structural equation model was used to analyze pathways among different variables.Results(1) 300 questionnaires were given out in this study. 290 questionnaireswere recycled. 274 questionnaires were valid. The valid response rate was 91.3%.(2) The total score of quality of life in patients with chronic heart failure was(42.59±10.62). The patients of different levels of monthly family income per capita, diagnosis time of heart failure, different types of chronic heart failure,New York Heart Association Functional Class, numbers of complication, the difference of quality of life was significant(P<0.05). The total score of symptom burden in patients with chronic heart failure was(0.97±0.42). The patients of different living arrangement, gender, diagnosis time of heart failure, different types of chronic heart failure, New York Heart Association Functional Class,numbers of complication, the difference of symptom burden was significant(P<0.05). The total score of self-efficacy of patients with chronic heart failure was(6.77±1.35). The patients of different living arrangement, monthly family income per capita, diagnosis time of heart failure, types of chronic heart failure, numbers of complication, the difference of self-efficacy was significant(P<0.05). The total score of social support of patients with chronic heart failure was(34.46±5.58). The patients of that different age, marital status, educational level, living arrangement,monthly family income per capita, types of chronic heart failure, the difference of social support was significant(P<0.05).(3)Pearson product-moment correlation analysis showed that symptom burden was positively correlated with quality of life( r =0.717, P<0.01). Self-efficacy was positively correlated with social support( r =0.252, P<0.01). Self-efficacy, social support was negatively correlated with quality of life. The coefficient productmoment correlation analysis was(-0.343~-0.678, P<0.01). Self-efficacy, social support was negatively correlated with symptom burden. The correlation coefficient was(-0.269~-0.683, P<0.01).(4) Multi-factor analysis showed that symptom burden, self-efficacy, social support explained the quality of life for59.8 percent of the variance.(5) The structural equation modeling indicated thatevery indicator of goodness-of-fit index was χ2/ df =2.730, GFI=0.942, AGFI=0.898, RMSEA=0.08, NFI=0.934, IFI=0.957, CFI=0.957. Quality of life in patients with chronic heart failure was directly effected by symptom burden(β=0.789, P<0.001). Social support had a direct negative effect on symptom burden(β=-0.357, P<0.001), a direct negative effect on quality of life by symptom burden(β=-0.161, P<0.05), the mediation effect was 0.282. Self-efficacy had no significant direct impact on quality of life(β=-0.436, P>0.05).Conclusion(1) Quality of life, symptom burden, social support, self-efficacy of patients with chronic heart failure were in medium level.(2) Symptom burden,self-efficacy, social support was influenced by demographic characters and disease variables of patients with chronic heart failure. Clinical medical staff should select reasonable symptom management strategy according to different features of patients in order to optimize the quality of life.(3) Symptom burden, self-efficacy, social support,quality of life of patients with chronic heart failure were related to each other. The quality of life was effectively predicted by symptom burden, self-efficacy and social support. The patients who were in high symptom burden, low self-efficacy, low social support should be selected for the emphasized intervention groups.(4) Social support in patients with chronic heart failure could directly or indirectly affect quality of life.Symptom burden played an intermediary role between social support and quality of life.Self-efficacy didn’t play a mediation role between symptom burden and quality of life.Clinical medical staff could reduce symptom burden, improve quality of life by raising the level of social support of patients with chronic heart failure. |
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