Document Type

Technical Report

Date of this Version

4-30-2016

Publication Source

International Journal of Nursing Studies

Volume

60

Start Page

191

Last Page

199

DOI

10.1016/j.ijnurstu.2016.04.016

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 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

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.

Copyright/Permission Statement

© 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/

Keywords

cognition, heart failure, mediation analysis, self-care, self-efficacy, treatment adherence

Share

COinS
 

Date Posted:09 November 2018

This document has been peer reviewed.