title: From novice to expert: confidence and activity status determine heart failure self-care performance.
abstract: BACKGROUND
  In a previous, small, mixed-methods study, heart failure patients were described as novice, expert, or inconsistent in self-care. In that study, self-care types differed in experience, confidence, attitudes, and skill.
  
  
  OBJECTIVE
  The aims of this study were to validate the novice-to-expert self-care typology and to identify determinants of the heart failure self-care types.
  
  
  METHODS
  A cross-sectional descriptive study was performed using data from 689 adults with heart failure (61 ± 2.5 years; 36% female, 50% New York Heart Association class III). Two-step likelihood cluster analysis was used to classify patients into groups using all items in the maintenance and management scales of the Self-care of Heart Failure Index. Multinomial regression was used to identify the determinants of each self-care cluster, testing the influence of age, gender, left ventricular ejection fraction, body mass index, depression, anxiety, hostility, perceived control, social support, activity status (Duke Activity Status Index), and self-care confidence.
  
  
  RESULTS
  Self-care behaviors clustered best into three types: novice (n = 185, 26.9%), expert (n = 229, 33.2%), and inconsistent (n = 275, 39.9%). The model predicting self-care cluster membership was significant (χ2 = 88.67, p < .001); Duke Activity Status Index score and Self-care of Heart Failure Index confidence score were the only significant individual factors. Higher activity status increased the odds that patients would be inconsistent (odds ratio [OR] = 1.02-1.09) or novice (OR = 1.02-1.10) in self-care. Higher self-care confidence increased the odds of being an expert (OR = 1.05-1.09) or inconsistent (OR = 1.01-1.05) in self-care.
  
  
  CONCLUSIONS
  The three-level typology of heart failure self-care was confirmed. Patients who have fewer limitations to daily activities may not be driven adequately to engage in heart failure self-care and may need extra assistance in developing expertise.
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia 19104-4217, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.forename: Nancy
authors.initials: N
authors.lastname: Albert
authors.forename: Terry
authors.initials: T
authors.lastname: Lennie
authors.forename: Misook
authors.initials: M
authors.lastname: Chung
authors.forename: Eun Kyeung
authors.initials: EK
authors.lastname: Song
authors.forename: Brooke
authors.initials: B
authors.lastname: Bentley
authors.forename: Seongkum
authors.initials: S
authors.lastname: Heo
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D001294:Attitude to Health; D016009:Chi-Square Distribution; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006301:Health Services Needs and Demand; D006333:Heart Failure / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D012044:Regression Analysis; D012648:Self Care / Q000145:classification / Q000523:psychology; D012647:Self-Assessment; D012944:Social Support; D014481:United States