Multiple Comorbid Conditions Challenge Heart Failure Self-Care by Decreasing Self-Efficacy

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): RO1HL083176 Improving Self-Care Behavior and Outcomes in Rural Patients with Heart Failure Background/Introduction: Patients with heart failure (HF) experience cardiac and non-cardiac related comorbid conditions. Such comorbidities create challenges to successful engagement in self-care of HF because patients are asked to simultaneously perform a variety of recommended self-care activities for HF and their comorbid conditions. It is possible that patients with a greater number of comorbid conditions experience more difficulty performing activities of HF self-care compared to those with a smaller number of comorbid conditions. However, it is also possible that types of comorbid conditions are more important factors influencing self-care of HF. Purpose To explore whether self-care of HF is associated with the number of comorbid conditions or types of comorbid conditions. Methods A total of 589 patients with HF (66 years, 41% female, 65% NYHA III/IV) were included in this study. The number of comorbid conditions was measured using the list of the conditions in the Charlson Comorbidity Index. Types of comorbidities were defined as follows: concordant conditions, sharing overall pathophysiologic risk profiles with HF, and discordant conditions, not being directly related to HF. Patients were categorized into 4 groups: HF patients without comorbidities; those with concordant conditions; those with discordant conditions; and those with both concordant and discordant conditions. Self-care was measured with the European HF self-care behavior scale. A multivariate linear regression was performed to explore the relationship of HF self-care with the number and types of comorbid conditions after adjusting for relevant covariates. Results The number of comorbid conditions was not associated with self-care of HF. However, the types of comorbid conditions were related to self-care of HF after controlling for covariates. Compared to HF patients without comorbidities, patients with both concordant and discordant conditions were more likely to have poorer self-care (β=0.155, 95% CI 0.29-4.09). However, levels of self-care in patients having either concordant or discordant conditions were not different from levels in patients having no comorbid conditions. Conclusion: Patients’ adherence to HF self-care was associated with the types of comorbidities, but not the simple count of comorbidities. Patients who had both concordant and discordant conditions were more likely to perform poor self-care of HF compared to those who had either concordant or discordant conditions or no comorbid conditions. It appears that HF patients with both concordant and discordant conditions experience difficulty integrating HF self-care in relation to a variety of conditions.

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Self-Efficacy of Older People Using Technology to Self-Manage COPD, Hypertension, Heart Failure, or Dementia at Home: An Overview of Systematic Reviews

The Gerontologist ◽

10.1093/geront/gnaa045 ◽

2020 ◽

Author(s):

Garuth Chalfont ◽

Céu Mateus ◽

Sandra Varey ◽

Christine Milligan

Keyword(s):

Heart Failure ◽

Older People ◽

Systematic Reviews ◽

Self Efficacy ◽

Patient Activation ◽

Self Care ◽

The Self ◽

Self Management ◽

Overview Of Systematic Reviews ◽

At Home

Abstract Background and Objectives Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home. Research Design and Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of “self-efficacy.” Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized. Results Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery. Discussion and Implications Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth’s adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.

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Abstract 13213: Correlates of Dietary Self-care Behaviors in Adults With Type 2 Diabetes and Comorbid Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.13213 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Fekadu Aga ◽

Sandra B Dunbar ◽

Tedla Kebede ◽

Melinda K Higgins ◽

Rebecca A Gary

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Self Efficacy ◽

Self Care ◽

Future Research ◽

Cardiac Device ◽

Diet Score ◽

Implanted Device ◽

Specific Diet

Introduction: Multi-morbidity is increasingly recognized to negatively influence self-care behaviors such as dietary adherence in persons living with serious or life-threatening chronic conditions such as type 2 diabetes (T2D) and heart failure (HF). Aim: The aim of this study was to describe demographic, clinical, and psychosocialcorrelates of dietary self-care behaviors in adult patients with T2D and comorbid HF. Methods: The parent study for this secondary analysis was a randomized trial that tested a 6-month integrated self-care intervention for 180 participants with comorbid HF and T2D. Cross-sectional, baseline data was used for the predictive model which included demographic (age, sex, marital status, and education) psychosocial (depression [PhQ-9], self-efficacy [PDSMS], and diabetes knowledge [MDKT]); and clinical variables (years diagnosed with T2D and HF, New York Heart Association (NYHA) functional classification, Charlson comorbidity index (CCI), and implanted cardiac device). The general and specific diet components of the Summary of Diabetes Self-Care Activities (SDSCA) were used to measure dietary self-care behaviors. Correlational bivariate and stepwise linear regression analyses were performed to examine correlates of dietary self-care behaviors. Results: Participants mean age was 58 ±11 years and the majority were male (n = 118, 66%) and African American (n = 119, 66%). Charlson comorbidity >2 ( p <0.05) and implanted device ( p <0.05) predicted lower SDSCA general diet score. Diabetes self-efficacy ( p <0.01) predicted higher SDSCA specific diet score while implanted cardiac device ( p <0.05) predicted lower score, collectively explaining 18.2% of the variance in diabetes-specific dietary self-care behavior. Conclusion: Findings suggest that multimorbidity may increase risk for lower diabetes dietary self-care behaviors, particularly those with more advanced HF requiring an implanted device. Future research should focus on how to promote effective self-care behaviors in persons living with multimorbidity as a strategy to improve clinical outcomes and enhance quality of life.

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A Proposed Model of the Relationships Between Health Literacy, Self-Care, Self-Efficacy, and Knowledge in Heart Failure

Heart & Lung ◽

10.1016/j.hrtlng.2013.06.031 ◽

2013 ◽

Vol 42 (4) ◽

pp. 300

Author(s):

K.S. Yehle ◽

A.M. Chen ◽

N.M. Albert ◽

K.F. Ferraro ◽

H.L. Mason ◽

...

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Self Efficacy ◽

Self Care ◽

Proposed Model

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Health Literacy Influences Heart Failure Knowledge Attainment but Not Self-Efficacy for Self-Care or Adherence to Self-Care over Time

Nursing Research and Practice ◽

10.1155/2013/353290 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Aleda M. H. Chen ◽

Karen S. Yehle ◽

Nancy M. Albert ◽

Kenneth F. Ferraro ◽

Holly L. Mason ◽

...

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Self Efficacy ◽

Repeated Measures ◽

Self Care ◽

Adequate Health Literacy ◽

Health Literacy Level ◽

Literacy Level ◽

Inadequate Health Literacy ◽

Over Time

Background. Inadequate health literacy may be a barrier to gaining knowledge about heart failure (HF) self-care expectations, strengthening self-efficacy for self-care behaviors, and adhering to self-care behaviors over time.Objective. To examine if health literacy is associated with HF knowledge, self-efficacy, and self-care adherence longitudinally.Methods. Prior to education, newly referred patients at three HF clinics (N=51, age:64.7±13.0years) completed assessments of health literacy, HF knowledge, self-efficacy, and adherence to self-care at baseline, 2, and 4 months. Repeated measures analysis of variance with Bonferroni-adjusted alpha levels was used to test longitudinal outcomes.Results. Health literacy was associated with HF knowledge longitudinally (P<0.001) but was not associated with self-efficacy self-care adherence. In posthoc analyses, participants with inadequate health literacy had less HF knowledge than participants with adequate (P<0.001) but not marginal (P=0.073) health literacy.Conclusions. Adequate health literacy was associated with greater HF knowledge but not self-efficacy or adherence to self-care expectations over time. If nurses understand patients’ health literacy level, they may educate patients using methods that promote understanding of concepts. Since interventions that promote self-efficacy and adherence to self-care were not associated with health literacy level, new approaches must be examined.

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