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Journal Article

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Research in Nursing & Health





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Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.

Copyright/Permission Statement

This is the peer reviewed version of the following article: [Bidwell, J.T. et al. 92015). Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: a Dyadic Analysis. Research in Nursing & Health 38, no. 5: 392-402], which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.


Activities of Daily Living, Adult, Age Distribution, Aged, Caregivers, Chronic Disease, Cohort Studies, Cross-Sectional Studies, Female, Heart Failure, Humans, Interpersonal Relations, Italy, Male, Middle Aged, Patient Compliance, Quality of Life, Self Care, Sex Distribution



Date Posted: 06 August 2018

This document has been peer reviewed.