title: Profiles of self-care management versus consulting behaviors in adults with heart failure.
abstract: BACKGROUND
  Patients with heart failure (HF) vary in their ability to respond to symptoms when they occur. The goal of this study was to classify common patterns of symptom response behaviors among adults with HF and identify biobehavioral determinants thereof.
  
  
  METHODS
  Consulting behaviors (i.e. contacting a provider for guidance) were measured using the European Heart Failure Self-care Behavior Scale consulting behaviors subscale, and self-care management (i.e. recognizing and engaging in self-initiated treatment of symptoms) was measured with the Self-Care of HF Index self-care management scale in a prospective cohort study. Latent class mixture modeling was used to identify distinct profiles of consulting and of self-care management behaviors.
  
  
  RESULTS
  The mean age (n=146) was 57±13 years, 30% were female, and 59% had class III/IV HF. Two distinct profiles of consulting behaviors (novice and expert) and three distinct profiles of self-care management (novice, inconsistent and expert) were identified. There was a weak association between profiles of consulting behaviors and self-care management (Kendall's tau-b=0.211). Higher levels of anxiety were associated with worse consulting behaviors (β=1.67±0.60) and worse self-care management (β= -5.82±3.12) and lower odds of exhibiting expert level consulting behaviors (odds ratio (OR)=0.50; 95% confidence interval (CI)=0.26-0.95) and self-care management (OR=0.47; 95% CI=0.24-0.92) (all p<0.05). Higher levels of physical symptoms were associated with better self-care management (β=0.50±0.12; OR =1.02, 95% CI=1.00-1.05; both p<0.05).
  
  
  CONCLUSIONS
  Expertise in consulting behaviors does not necessarily confer expertise in symptom self-care management and vice versa. Physical and psychological symptoms are strong determinants of symptom response behaviors.
authors.affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, USA School of Nursing, Oregon Health & Science University, USA csleern@gmail.com.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, USA.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Gelow
authors.affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Mudd
authors.affiliation: School of Nursing, Oregon Health & Science University, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Green
authors.affiliation: School of Nursing, Oregon Health & Science University, USA.
authors.forename: Shirin O
authors.initials: SO
authors.lastname: Hiatt
authors.affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Chien
authors.affiliation: School of Nursing, University of Pennsylvania, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D057240:Patient Preference / Q000523:psychology / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Heart failure; consulting behaviors; self-care; symptom management