Study On Self-care Behaviors Of Patients With Chronic Heart Failure And Its Influencing Factors

Objectives:1.To develop a conceptual framework about the influencing factors of self-care behaviors in chronic heart failure(CHF)patients.2.To describe self-care behaviors in CHF patients.3.To explore influencing factors of self-care behaviors in CHF patients and the influence path.Methods:1.The development of the conceptual framework about influencing factors of self-care behaviors in CHF patients.According to the situation-specific theory of heart failure self-care and the results of literature review,the first draft of conceptual framework about the influencing factors of self-care behaviors had been put forward.Then two rounds of consultation were conducted among 15 experts to screen influencing factors of self-care behaviors.2.The cross-sectional survey on self-care behaviors and its influencing factors in CHF patients.A total of 231 dyads of CHF patients and their caregivers were selected from an outpatient clinic in a tertiary general hospital using a convenient sampling method.Data were collected with Charlson Comorbidity Index(CCI),Minnesota Heart Failure Quality of Life Scale(MLHFQ)symptoms related items,Atlanta HF Knowledge Test(AHFKT-V2),Caregiver Contribution to Self-care of Heart Failure Index(CC-SCHFI),and Self-care of Heart Failure Index(SCHFIv6.2).Stastical analysis methods including: statistical description,univariate analysis and path analysis.Results:1.The recovery rate were both 100.00%,and the authority coefficientwere both 0.94 in two rounds of consultation.The Kendall's coefficient concordance of index in two rounds of consultation was between 0.209 and0.768 and between 0.227 and 0.468(P<0.05),respectively.The conceptual framework of 5 first-level indicators and 18 second-level indicators has been established.2.Scores of self-care maintenance in CHF patients ranged from 10.00 to86.66,with an average score of(41.83±16.86).Scores of self-care management in CHF patients ranged from 0 to 100.00,with an average score of(41.53±16.29).3.Among self-care maintenance,patients performed the best adherence to medication,while the worst adherence to vaccination;among self-care management,patients performed the best adherence to identify heart failure symptoms,while the worst adherence to add diuretics when symptoms appeared.4.Path analysis results showed that: LVEF(?50%),CCI(?5),caregiver contribution to heart failure self-care maintenance,patient's knowledge and skills and self-care confidence had direct effects on self-care maintenance,and direct effects were 0.13,-0.12,0.38,0.23,and 0.12,respectively(P<0.05).Number of hospitalizations,caregiver contribution to heart failure self-care management,self-care confidence,and self-care maintenance had direct effects on self-care management,and direct effects were 0.12,0.14,0.46,0.43,respectively(P<0.05).Education,caregiver's knowledge and skills indirectly affected self-care maintenance through patient's knowledge and skills,and indirect effects were 0.05 and 0.13,respectively(P<0.05).Education and caregiver's knowledge and skills indirectly affected self-care management through patient's knowledge and skills and self-care maintenance,and indirect effects were 0.02 and 0.06,respectively(P<0.05);monthly income,number of hospitalizations,caregiver contribution to heart failure self-care management,and caregiver confidence indirectly affected self-care management through self-care confidence,and indirect effects were 0.09,-0.07,0.07,and 0.14,respectively(P<0.05);LVEF(? 50%),CCI(?5),caregiver contribution to heart failure self-care maintenance,patient's knowledge and skills,and self-care confidence indirectly affected self-care management through self-care maintenance,and indirect effects were 0.06,-0.05,0.16,0.10,and0.05,respectively,respectively(P<0.05).The model can explain 30% of the variance in self-care maintenance and 54% of the variance in self-care management.Conclusions:1.Consultation results were reliable.We can explore influencing factors of self-care behaviors based on the framework.2.The overall level of self-care behaviors in CHF patients is poor and adherence to different self-care behaviors varies greatly.3.LVEF(?50%),CCI(?5),caregiver contribution to heart failure self-care maintenance,patient's knowledge and skills and self-care confidence directly affect self-care maintenance;number of hospitalizations,caregiver contribution to heart failure self-care management,self-care confidence,and self-care maintenance direct affect self-care management.Education,caregiver's knowledge and skills indirectly affected self-care maintenance.Education,monthly income,LVEF(?50%),CCI(?5),number of hospitalizations,caregiver's knowledge and skills,all demensions of caregiver contribution to heart failure self-care,patient's knowledge and skills,and self-care confidence can indirectly affect self-care management.4.To improve self-care behaviors of CHF patients,healthcare providers can develop targeted interventions according to the above factors,guiding by the conceptual framework of the factors influencing self-care behaviors of CHF patients.