| ObjectiveTo survey the status quo of the mutuality between patients with chronic heart failure(CHF)and their caregivers,explore the relevant influencing factors,and establish a structural equation model of the relationship between health literacy,social support,coping style,caregiver preparedness and mutuality for patients with CHF.To investigate the pathways between patients’health literacy,social support,coping style,caregiver preparedness and patients’mutuality.To provide a theoretical basis for clinical medical staff to implement targeted intervention strategies,ameliorate the level of the mutuality between patients with CHF and their caregivers,and improve the end-stage life quality of patients.MethodsWe identified the main influencing factors of the mutuality between patients with CHF and their caregivers through literature analysis,and proposed the model hypothesis of the influencing factors.From March 2022 to September,We applied the cross-sectional study method and convenience sampling to select a total of 273 pairs of patients with CHF and their caregivers who were admitted to the Department of cardiovascular medicine and department of cardiovascular medicine for the elderly of Grade A tertiary hospital in Nanjing as the research objects.The survey tools included the patients’and caregivers’general information questionnaire,Mutuality Scale(MS),Chronic Disease Health Literacy Scale,Social Support Rating Scale(SSRS),Simplified Coping Style Questionnaire(SCSQ)and Caregiver Preparedness Scale(CPS).We used SPSS 23.0 statistical software to conduct descriptive analysis,single factor analysis,correlation analysis and multiple linear regression analysis,and used AMOS 21.0 software to construct and analyze the structural equation model of related influencing factors.Results1.The study showed that a total of 273 pairs of patients with CHF and their caregivers who finished the survey.The average age of patients was(67.24±13.71)years old,including 166males(60.81%)and 107 females(39.19%),and the average left ventricular ejection fraction(LVEF)was(44.43±10.15)%.The average age of caregivers was(59.90±13.62)years old,including 106 males(38.83%)and 167 females(61.17%).2.The average score of patients’mutuality was(2.12±0.79)point,which was higher than that of caregivers(2.02±0.66)point,and the difference was statistically significant(P<0.05),and both were at the lower middle level.The total score of patients’health literacy was(83.20±27.99)point,the average score of items was(3.47±1.17)point.The total score of social support was(23.91±6.31)points,the average score of each item was(2.39±0.63)points.The total score of positive coping style was(15.50±6.33)points,the average score of each item was(1.10±0.53)points.And the total score of negative coping style was(8.82±3.95)points,the average score of each item was(1.22±0.38)points.The total score of caregiver preparedness was(17.70±7.05)points,and the average score of each item was(2.21±0.88)points.3.The results of univariate analysis showed that the mutuality scores of patients with chronic heart failure had statistically significant differences in different cardiac function grades,types of complications,left ventricular ejection fraction and caregiver age(P<0.05).4.The correlation analysis results of patients’health literacy,social support,coping style,caregiver preparedness and patients’mutuality showed that the total score of patients’mutuality was positively correlated with the total score of patients’health literacy(r=0.461,P<0.01),information acquisition ability(r=0.498,P<0.01),communication and interaction ability(r=0.414,P<0.01),willingness to improve health(r=0.384,P<0.01),and had no correlation with willingness to financial support(r=0.057,P>0.05).It was positively correlated with the total score of social support(r=0.400,P<0.01),objective support(r=0.495,P<0.01),subjective support(r=0.202,P<0.01)and support availability(r=0.299,P<0.01).It was positively correlated with the score of positive coping style(r=0.358,P<0.01)and negatively correlated with the score of negative coping style(r=-0.289,P<0.01).And it was positively correlated with the score of caregiver preparedness(r=0.132,P<0.01).5.The results of multiple linear stepwise regression analysis showed that,LVEF,the scores of information acquisition ability,objective support,subjective support,positive coping style,negative coping style and caregiver preparedness entered the regression equation model,which explained 51.7%of the total variation of patients’mutuality together,and there was a significant linear relationship(Adjusted R~2=0.491,F=19.758,P<0.001).6.Path analysis showed that patients’health literacy had a direct positive effect on patients’ mutuality(β=0.284,P<0.01),social support had a direct positive effect on mutuality(β=0.287,P<0.01),positive coping style had a direct positive effect on mutuality(β=0.200,P<0.01),negative coping style had a direct negative effect on mutuality(β=-0.131,P<0.05),and caregiver preparedness had a direct positive effect on the patients’mutuality(β=0.174,P<0.01).The total effect of CHF patients’health literacy on the patients’mutuality was 0.194,the direct effect was 0.164,the indirect effect was 0.030,and the mediating effect accounted for 15.46%of the total effect.Social support had a significant mediating effect in the path of"health literacy→social support→mutuality",and the mediating effect accounted for 11.86% of the total effect.Social support and positive coping style had a significant mediating effect in the path of"health literacy→social support→positive coping style→mutuality",and the mediating effect accounted for 4.64%of the total effect.Conclusions1.The level of the mutuality between patients with CHF and their caregivers is lower than the medium level,it is suggested that medical staff should pay attention to the level of mutuality between patients and their caregivers.2.There are many factors affecting the mutuality between patients with CHF and their caregivers.The health literacy,social support,coping style and caregiver preparedness of patients with CHF are the important factors affecting the mutuality of patients with CHF.3.CHF patients’social support and positive coping styles partially mediate the relationship between health literacy and patients’mutuality,and caregiver preparedness can also play a partial chain mediating role between social support and patients’mutuality.It is suggested that medical staff should regard patients and their caregivers as a whole,carry out training from many different aspects such as patient’health literacy and caregiver preparedness,and construct targeted binary intervention programs to improve the level of mutuality between them. |
