Factors Associated With Family Caregiver Contribution To Self-care Of Heart Failure

ObjectiveBased on Information-Motivation-Behavioral skills(IMB)model,to explore factors associated with family caregiver contribution to self-care of heart failure(HF),and further to compensate for inadequate self-care in patients and improve quality of life in families with HF.MethodsA cross-sectional study was used to recruit 243 dyads of patients with HF and their family caregivers in a university hospital from December 2015 to June 2016.Data was collected with self-reported questionnaire for patients and family caregivers,Caregiver Contribution to Self-Care of Heart Failure Index(CC-SCHFI),Heart Failure Knowledge Test(HFKT),Social Support Rating Scale(SSRS)and Family Caregiver Task Inventory(FCTI).Statistical analysis was conducted with SPSS 20.0.Results1.The scores for caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF were 52.40 ± 9.96 and 55.61 ± 16.29.2.Relationships between different characteristics of patients and family caregivers and caregiver contribution to self-care of HF(1)The scores for family caregivers of patients who were less than high school educationed,farmers and diagnosed with chronic HF<6 months were lower than scores for those who were high school or vocational school educated,brainworkers,retired and diagnosed with chronic HF>36 months in caregiver contribution to self-care maintenance of HF(all P<0.05).The scores for family caregivers of patients who were partnered,less than high school educated,farmers and diagnosed with chronic HF ?12 months were lower than scores for those who were not partnered,high school or vocational school educated,retired and diagnosed with chronic HF>36 months in caregiver contribution to self-care management of HF(all P<0.05).(2)The scores for family caregivers who were practitioners(farming,other physical labor,brainwork),living in rural area,had monthly income<1000 ? were lower than scores for those who were retired,living in urban area,had monthly income>1000 ?(all P<0.05)in caregiver contribution to self-care maintenance of HF.The scores for family caregivers who were less than high school educated,practitioners(farming,other physical labor,brainwork),living in rural area,and had monthly income<1000 ? were lower than scores for those who were above high school educated,retired,brainworkers,living in urban area and had monthly income>5000 ? in caregiver contribution to self-care management of HF(all P<0.05).3.Relationships of HF knowledge,caregiver confidence,social support and caregiving tasks with caregiver contribution to self-care of HF(1)The score for HF knowledge(4.70 ± 2.11)was positively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r = 0.221,P<0.01;r = 0.410,P<0.01).(2)The score for caregiver confidence(55.26±16.32)was positively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r = 0.263,P<0.01;r = 0.469,P<0.01).(3)The score for social support(41.84 ± 6.70)was positively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r = 0.140,P<0.05;r = 0.281,P<0.01).The score for objective support(11.05±1.96)was positively correlated with caregiver contribution to self-care management of HF(r = 0.236,P<0.01);score for subjective support(24.00±4.42)was positively correlated with caregiver contribution to self-care management of HF(r = 0.236,P<0.01);score for support availability(6.79±2.31)was positively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r = 0.190,P<0.01;r = 0.264,P<0.01).(4)The score for caregiving tasks(5.03±4.65)was negatively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r =-0.202,P<0.01;r =-0.311,P<0.01).The score for learning to cope with new role(1.03±1.15)was negatively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r =-0.260,P<0.01;r =-0.346,P<0.01);score for providing care according to care-receiver's needs(0.59±4.42)was negatively correlated with caregiver contribution to self-care management of HF(r =-0.188,P<0.01);score for managing own emotional needs(0,68 ± 1.38)was negatively correlated with caregiver contribution to self-care management of HF(r =-0.246,P<0.01);score for appraising supportive resources(0.95 ± 1.25)was negatively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r =-0.135,P<0.05;r =-0.235,P<0.01);score for balancing caregiving and own needs(1.79 ? 1.93)was negatively correlated with caregiver contribution to self-care maintenance and caregiver contribution to self-care management of HF(r =-0.156,P<0.05;r =-0.188,P<0.01).4.Factors associated with caregiver contribution to self-care of HF(1)After multiple regression analysis,factors associated with family caregiver contribution to self-care maintenance of HF were patients' high school or vocational school education(less than high school as reference),caregivers lived in urban area(lived in rural area as reference),caregiver confidence and support availability of family caregivers.These four variables explained 18.6%of the variance in caregiver contribution to self-care maintenance of HF(Adjusted R2 = 0.186).(2)After multiple regression analysis,factors associated with family caregiver contribution to self-care management of HF were HF knowledge,caregiver confidence,objective support,learning to cope with new role and balancing caregiving and own needs.These five variables explained 38.8%of the variance in caregiver contribution to self-care management of HF(Adjusted R2=0.388).5.The mediating effects of learning to cope with new role and appraising supportive resourcesBaron and Kenny analyses indicated that learning to cope with new role partly mediated the relationship between HF knowledge,caregiver confidence,objective support and caregiver contribution to self-care management of HF(all P<0.05);and appraising supportive resources partly mediated the relationship between objective support and caregiver contribution to self-care management of HF(P<0.05).Conclusions1.There are differences in caregiver contribution to self-care of HF by various patient and family caregiver characteristics.The clinical nurses should improve caregiver contribution to self-care of HF in the families who were with lower education,lower income level,shorter HF duration and living in rural area.2.Factors associated with family caregiver contribution to self-care maintenance of HF are caregiver confidence,support availability,the education of patients and living area of family caregivers.3.Factors associated with family caregiver contribution to self-care management of HF are HF knowledge,caregiver confidence,objective support,learning to cope with new role and balancing caregiving and own needs.4.HF knowledge and caregiver confidence have direct and indirect effects(by learning to cope with new role)on caregiver contribution to self-care management of HF;objective support has direct and indirect effects(by learning to cope with new role and appraising supportive resources)on caregiver contribution to self-care management of HF.5.The clinical nurses should strengthen HF knowledge,caregiver confidence,objective support and support availability in family caregivers,to assist them adapt to caregiving role,and further to improve family caregiver contribution to self-care management of HF.