Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure
published online 17 February 2009.
Objective
Self-care is a key component in the management of chronic heart failure (CHF). Yet there are many barriers that interfere with a patient's ability to undertake self-care. The primary aim of the study was to test a conceptual model of determinants of CHF self-care. Specifically, we hypothesized that cognitive function and depressive symptoms would predict CHF self-care.
Methods
Fifty consecutive patients hospitalized with CHF were assessed for self-care (Self-Care of Heart Failure Index), cognitive function (Mini Mental State Exam), and depressive symptoms (Cardiac Depression Scale) during their index hospital admission. Other factors thought to influence self-care were tested in the model: age, gender, social isolation, self-care confidence, and comorbid illnesses. Multiple regression was used to test the model and to identify significant individual determinants of self-care maintenance and management.
Results
The model of 7 variables explained 39% (F [7, 42] 3.80; P = .003) of the variance in self-care maintenance and 38% (F [7, 42] 3.73; P = .003) of the variance in self-care management. Only 2 variables contributed significantly to the variance in self-care maintenance: age (P < .01) and moderate-to-severe comorbidity (P < .05). Four variables contributed significantly to the variance in self-care management: gender (P < .05), moderate-to-severe comorbidity (P < .05), depression (P < .05), and self-care confidence (P < .01). When cognitive function was removed from the models, the model explained less of the variance in self-care maintenance (35%) (F [6, 43] 3.91; P = .003) and management (34%) (F [6, 43] 3.71; P = .005).
Conclusion
Although cognitive function added to the model in predicting both self-care maintenance and management, it was not a significant predictor of CHF self-care compared with other modifiable and nonmodifiable factors. Depression explained only self-care management.
aFaculty of Health, Medicine, Nursing and Behavioral Sciences, Deakin University, Melbourne, Australia
bSchool of Nursing and Midwifery (Victoria), Faculty of Health Sciences, Australian Catholic University Limited, Victoria, Australia
cSchool of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
dPreventative Cardiology, Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia
Reprint requests: Janette Cameron, BN, MHLTHSCI, St Vincent's Health/ACU National Centre for Nursing Research, PO Box 2900, Fitzroy Victoria, Australia 3065
J.C. is supported by an NH&MRC/NHF Public Health Postgraduate Scholarship.
ABSTRACT