Self-care confidence may be more important than cognition to influence self-care behaviors in adults with heart failure: Testing a mediation model

Ercole Vellone, Luca Pancani, Andrea Greco, Patrizia Steca, Barbara Riegel
2016 International Journal of Nursing Studies  
Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding. Objectives The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. Design Secondary analysis of data from a descriptive study. Settings Three
more » ... ent sites in Pennsylvania and Delaware, USA. Participants A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). Methods Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. Results Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929-.968; root mean squared error of approximation range: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care. Conclusions This technical report is available at ScholarlyCommons: https://repository.upenn.edu/nrs/187 Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population. Abstract Background. Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding. Objectives. The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. Design. Secondary analysis of data from a descriptive study. Settings. Three out-patient sites in Pennsylvania and Delaware, USA. Participants. A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). Methods. Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. Results. Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index ranges: .929-.968; root mean squared error of approximation ranges: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care. Conclusions. Self-care confidence appears to be an important factor influencing heart failure selfcare even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population. adherence Contribution of the paper What is already known about the topic? • Cognitive impairment affects 25-50% of adults with heart failure; • Cognitive impairment may reduce HF patient self-care but literature is inconsistent; • Only one study reports that self-care confidence mediates between global cognition and heart failure self-care. What this study adds? • Self-care confidence totally mediates the relationship between simple attention and heart failure self-care; • Self-care confidence totally mediates the relationship between working memory and heart failure self-care. • Interventions addressing self-care confidence might be more effective than interventions based on cognitive training to improve self-care of heart failure patients
doi:10.1016/j.ijnurstu.2016.04.016 pmid:27297380 fatcat:zdmwhbv7jzgjbfhxurm52j6dqq