Beyond social support: Self-care confidence is key for adherence in patients with heart failure

Abstract

Background:

Adherence to treatment is crucial to improve outcomes in patients with heart failure. Good social support is associated with better adherence, but the mechanism for this association has not been well-explored.

Aims:

The aim of this secondary analysis was to examine whether self-care confidence mediates the relationship between social support and treatment adherence in heart failure patients hospitalized with acute exacerbation.

Methods:

A total of 157 inpatients with heart failure (63.5±13 years, 73% New York Heart Association class III/IV) were recruited from two hospitals located in urban areas in the USA. Participants completed the Self-Care of Heart Failure Index, the Multidimensional Perceived Social Support Scale, and the Medical Outcomes Study Specific Adherence Scale. A series of regression models were used to determine the mediation relationship.

Results:

Controlling for marital status and hospital site, social support was associated with adherence (p=0.03). When self-confidence was included in the model, the effect of social support became non-significant, indicating full mediation of the relationship between social support and adherence by self-care confidence. The indirect effect (0.04) of social support on adherence through self-confidence was significant (95% confidence interval: 0.01–0.09).

Conclusion:

Heart failure self-care confidence mediated the relationship between social support and treatment adherence. Thus interventions targeting patients’ self-care confidence is essential to maximize patients’ treatment adherence.

Keywords

Heart failure social support self-care confidence adherence

Get full access to this article

View all access options for this article.

References

Ponikowski

Voors

Anker

et al . 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Rev Esp Cardiol (Engl Ed) 2016; 69: 1167.

Mozaffarian

Benjamin

et al . Heart disease and stroke statistics–2016 update: A report from the American Heart Association. Circulation 2016; 133: e38–e360.

Jones

Holmes

Dewalt

et al . Is adherence to weight monitoring or weight-based diuretic self-adjustment associated with fewer heart failure-related emergency department visits or hospitalizations? J Card Fail 2012; 18: 576–584.

Marti

Georgiopoulou

Giamouzis

et al . Patient-reported selective adherence to heart failure self-care recommendations: A prospective cohort study: The Atlanta Cardiomyopathy Consortium. Congest Heart Fail 2013; 19: 16–24.

Lee

Moser

Lennie

et al . Event-free survival in adults with heart failure who engage in self-care management. Heart Lung 2011; 40: 12–20.

Jaarsma

Klompstra

Gal

et al . Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: The rationale, design and methodology of the HF-Wii study; a multicentre randomized controlled trial. Eur J Heart Fail 2015; 17: 743–748.

Horowitz

Rein

Leventhal

. A story of maladies, misconceptions and mishaps: Effective management of heart failure. Soc Sci Med 2004; 58: 631–643.

Scrutinio

Passantino

Guida

et al . Prognostic impact of comorbidities in hospitalized patients with acute exacerbation of chronic heart failure. Eur J Intern Med 2016; 34: 63–67.

Buck

Dickson

Fida

et al . Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care. Int J Nurs Stud 2015; 52: 1714–1722.

10.

Riegel

Vaughan Dickson

Goldberg

et al . Factors associated with the development of expertise in heart failure self-care. Nurs Res 2007; 56: 235–243.

11.

Graven

Grant

. Social support and self-care behaviors in individuals with heart failure: An integrative review. Int J Nurs Stud 2014; 51: 320–333.

12.

Maeda

Shen

Schwarz

et al . Self-efficacy mediates the associations of social support and depression with treatment adherence in heart failure patients. Int J Behav Med 2013; 20: 88–96.

13.

Magrin

D’Addario

Greco

et al . Social support and adherence to treatment in hypertensive patients: A meta-analysis. Ann Behav Med 2015; 49: 307–318.

14.

Salyer

Schubert

Chiaranai

. Supportive relationships, self-care confidence, and heart failure self-care. J Cardiovasc Nurs 2012; 27: 384–393.

15.

Riegel

Dickson

Faulkner

. The situation-specific theory of heart failure self-care: Revised and updated. J Cardiovasc Nurs 2016; 31: 226–235.

16.

Lee

Boo

et al . Physical functioning, physical activity, exercise self-efficacy, and quality of life among individuals with chronic heart failure in Korea: A cross-sectional descriptive study. J Nurs Res 2017; 25: 131–139.

17.

Riegel

Lee

Albert

et al . From novice to expert: Confidence and activity status determine heart failure self-care performance. Nurs Res 2011; 60: 132–138.

18.

Cene

Haymore

Dolan-Soto

et al . Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure. J Card Fail 2013; 19: 202–210.

19.

DiMatteo

Sherbourne

Hays

et al . Physicians’ characteristics influence patients’ adherence to medical treatment: Results from the Medical Outcomes Study. Health Psychol 1993; 12: 93–102.

20.

Sherbourne

Hays

Ordway

et al . Antecedents of adherence to medical recommendations: Results from the Medical Outcomes Study. J Behav Med 1992; 15: 447–468.

21.

Hays

Kravitz

Mazel

et al . The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study. J Behav Med 1994; 17: 347–360.

22.

Blumenthal

Burg

Barefoot

et al . Social support, type A behavior, and coronary artery disease. Psychosom Med 1987; 49: 331–340.

23.

Zimet

Powell

Farley

et al . Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess 1990; 55: 610–617.

24.

Canty-Mitchell

Zimet

. Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. Am J Community Psychol 2000; 28: 391–400.

25.

Riegel

Lee

Dickson

et al . An update on the self-care of heart failure index. J Cardiovasc Nurs 2009; 24: 485–497.

26.

Mills

Jr Haught

. Evaluation of heart failure patients: Objective parameters to assess functional capacity. Clin Cardiol 1996; 19: 455–460.

27.

Bennett

Riegel

Bittner

et al . Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung 2002; 31: 262–270.

28.

Hayes

. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press, 2013.

29.

Vellone

Fida

D’Agostino

et al . Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure. Int J Nurs Stud 2015; 52: 1705–1713.

30.

Gallagher

Luttik

Jaarsma

. Social support and self-care in heart failure. J Cardiovasc Nurs 2011; 26: 439–445.

31.

Sebern

Riegel

. Contributions of supportive relationships to heart failure self-care. Eur J Cardiovasc Nurs 2009; 8: 97–104.

32.

Cohen

Wills

. Stress, social support, and the buffering hypothesis. Psychol Bull 1985; 98: 310–357.

33.

Sayers

Riegel

Pawlowski

et al . Social support and self-care of patients with heart failure. Ann Behav Med 2008; 35: 70–79.