Testing a model of patient characteristics, psychologic status, and cognitive function as predictors of self-care in persons with chronic heart failure.
OBJECTIVE
Self-care is a key component in the management of chronic heart failure (CHF). Yet there are many barriers that interfere with a patient's ability to undertake self-care. The primary aim of the study was to test a conceptual model of determinants of CHF self-care. Specifically, we hypothesized that cognitive function and depressive symptoms would predict CHF self-care.


METHODS
Fifty consecutive patients hospitalized with CHF were assessed for self-care (Self-Care of Heart Failure Index), cognitive function (Mini Mental State Exam), and depressive symptoms (Cardiac Depression Scale) during their index hospital admission. Other factors thought to influence self-care were tested in the model: age, gender, social isolation, self-care confidence, and comorbid illnesses. Multiple regression was used to test the model and to identify significant individual determinants of self-care maintenance and management.


RESULTS
The model of 7 variables explained 39% (F [7, 42] 3.80; P = .003) of the variance in self-care maintenance and 38% (F [7, 42] 3.73; P = .003) of the variance in self-care management. Only 2 variables contributed significantly to the variance in self-care maintenance: age (P < .01) and moderate-to-severe comorbidity (P < .05). Four variables contributed significantly to the variance in self-care management: gender (P < .05), moderate-to-severe comorbidity (P < .05), depression (P < .05), and self-care confidence (P < .01). When cognitive function was removed from the models, the model explained less of the variance in self-care maintenance (35%) (F [6, 43] 3.91; P = .003) and management (34%) (F [6, 43] 3.71; P = .005).


CONCLUSIONS
Although cognitive function added to the model in predicting both self-care maintenance and management, it was not a significant predictor of CHF self-care compared with other modifiable and nonmodifiable factors. Depression explained only self-care management.
Cameron
Janette
J
Deakin University, Melbourne, Australia.
Worrall-Carter
Linda
L
Riegel
Barbara
B
Lo
Sing Kai
SK
Stewart
Simon
S
D000223:Adaptation, Psychological; D000368:Aged; D002908:Chronic Disease; D003071:Cognition; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008960:Models, Psychological; D008962:Models, Theoretical; D015999:Multivariate Analysis; D011446:Prospective Studies; D011594:Psychometrics; D012044:Regression Analysis; D012648:Self Care; D012649:Self Concept; D013315:Stress, Psychological / Q000150:complications* / Q000628:therapy