Date of this Version
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.
The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care.
Secondary analysis of data from a descriptive study.
Three out-patient sites in Pennsylvania and Delaware, USA.
A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%).
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.
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.
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.
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
cognition, heart failure, mediation analysis, self-care, self-efficacy, treatment adherence
Vellone, E., Pancani, L., Greco, A., Steca, P., & Riegel, B. (2016). Self-Care Confidence May be More Important than Cognition to Influence Self-Care Behaviors in Adults with Heart Failure: Testing a Mediation Model. International Journal of Nursing Studies, 60 191-199. http://dx.doi.org/10.1016/j.ijnurstu.2016.04.016
Behavioral Medicine Commons, Cardiology Commons, Cardiovascular Diseases Commons, Circulatory and Respiratory Physiology Commons, Medical Humanities Commons, Nursing Commons, Preventive Medicine Commons
Date Posted: 09 November 2018
This document has been peer reviewed.