Document Type

Technical Report

Date of this Version

7-3-2015

Publication Source

International Journal of Nursing Studies

Volume

52

Issue

11

Start Page

1705

Last Page

1713

DOI

10.1016/j.ijnurstu.2015.06.013

Abstract

Background

Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care.

Objective

The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors.

Design

A secondary analysis of data from a cross-sectional study.

Setting

Outpatient heart failure clinics in 28 Italian provinces.

Participants

628 Italian heart failure patients.

Methods

We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data.

Results

Participants were 73 years old on average (SD = 11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index = 1.0; root mean square error of approximation = 0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management.

Conclusion

Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition.

Copyright/Permission Statement

© 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

Keywords

cognition, cross-sectional studues, heart failure, medication adherence, mild cognitive impairment, nursing theory, self care, self efficacy

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Date Posted:09 November 2018

This document has been peer reviewed.