title: A Dyadic Approach to Managing Heart Failure With Confidence.
abstract: BACKGROUND
  The majority of heart failure (HF) self-care research remains focused on patients, despite the important involvement of family caregivers. Although self-care confidence has been found to play an important role in the effectiveness of HF self-care management on patient outcomes, no known research has examined self-care confidence within a dyadic context.
  
  
  OBJECTIVE
  The purpose of this study was to identify individual and dyadic determinants of self-care confidence in HF care dyads.
  
  
  METHODS
  Multilevel modeling, which controls for the interdependent nature of dyadic data, was used to examine 329 Italian HF dyads (caregivers were either spouses or adult children).
  
  
  RESULTS
  Both patients and caregivers reported lower-than-adequate levels of confidence, with caregivers reporting slightly higher confidence than patients. Patient and caregiver levels of confidence were significantly associated with greater patient-reported relationship quality and better caregiver mental health. Patient confidence in self-care was significantly associated with patient female gender, nonspousal care dyads, poor caregiver physical health, and low care strain. Caregiver confidence to contribute to self-care was significantly associated with poor emotional quality of life in patients and greater perceived social support by caregivers.
  
  
  CONCLUSIONS
  Findings are supportive of the need for a dyadic perspective of HF self-care in practice and research as well as the importance of addressing the needs of both members of the dyad to maximize optimal outcomes for both.
authors: Karen S. Lyons, PhD Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA. Ercole Vellone, PhD, RN Research fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. Christopher S. Lee, PhD, RN, FAHA, FAAN Associate Professor, School of Nursing, Oregon Health & Science University, Portland. Antonello Cocchieri, PhD, RN Consultant, Nursing Service, Catholic University, Rome, Italy. Julie T. Bidwell, BSN, RN PhD Student, School of Nursing, Oregon Health & Science University, Portland. Fabio D'Agostino, PhD, RN Research fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. Shirin O. Hiatt, MPH, MS, RN Research Associate, School of Nursing, Oregon Health & Science University, Portland. Rosaria Alvaro, MSN, RN Associate Professor, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy. Raul Juarez Vela, PhD, RN Research Fellow, Faculty of Health Sciences, University San Jorge, Zaragoza, Spain. Barbara Riegel, PhD, RN, FAHA, FAAN Professor, School of Nursing, University of Pennsylvania, Philadelphia.
authors: Karen S
authors: KS
authors: Lyons
authors: Ercole
authors: E
authors: Vellone
authors: Christopher S
authors: CS
authors: Lee
authors: Antonello
authors: A
authors: Cocchieri
authors: Julie T
authors: JT
authors: Bidwell
authors: Fabio
authors: F
authors: D'Agostino
authors: Shirin O
authors: SO
authors: Hiatt
authors: Rosaria
authors: R
authors: Alvaro
authors: Raul Juarez
authors: RJ
authors: Vela
authors: Barbara
authors: B
authors: Riegel
mesh_terms: D000368:Aged; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D003430:Cross-Sectional Studies; D004644:Emotions; D005195:Family Relations; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D012649:Self Concept