Multiple comorbid conditions challenge heart failure self-care by decreasing self-efficacy.
BACKGROUND
Most heart failure patients have multiple comorbidities.


OBJECTIVE
This study aims to test the moderating effect of comorbidity on the relationship between self-efficacy and self-care in adults with heart failure.


METHODS
Secondary analysis of four mixed methods studies (n = 114) was done. Self-care and self-efficacy were measured using the Self-Care of Heart Failure Index. Comorbidity was measured with the Charlson Comorbidity Index. Parametric statistics were used to examine the relationships among self-efficacy, self-care, and the moderating influence of comorbidity. Qualitative data yielded themes about self-efficacy in self-care and explained the influence of comorbidity on self-care.


RESULTS
Most (79%) reported two or more comorbidities. There was a significant relationship between self-care and the number of comorbidities (r = -.25; p = .03). There were significant differences in self-care by comorbidity level (self-care maintenance, F[1, 112], 5.96, p = .019, and self-care management, F[1, 72], 4.66, p = .034). Using moderator analysis of the effect of comorbidity on self-efficacy and self-care, a significant effect was found only in self-care maintenance among those who had moderate levels of comorbidity (b = .620, p = .022, F(change) df[6,48], 5.61, p = .022). In the qualitative data, self-efficacy emerged as an important variable influencing self-care by shaping how individuals prioritized and integrated multiple and often competing self-care instructions.


CONCLUSIONS
Comorbidity influences the relationship between self-efficacy and self-care maintenance, but only when levels of comorbidity are moderately high. Methods of improving self-efficacy may improve self-care in those with multiple comorbidities.
College of Nursing, New York University, New York, NY 10003, USA. vdickson@nyu.edu
Victoria Vaughan
VV
Dickson
Harleah
H
Buck
Barbara
B
Riegel
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006333:Heart Failure / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care; D020377:Self Efficacy