title: Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure.
abstract: BACKGROUND
  Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care.
  
  
  OBJECTIVE
  The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors.
  
  
  METHODS
  A secondary analysis of data from a cross-sectional study.
  
  
  METHODS
  Outpatient heart failure clinics in 28 Italian provinces.
  
  
  METHODS
  628 Italian heart failure patients.
  
  
  METHODS
  We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data.
  
  
  RESULTS
  Participants were 73 years old on average (SD=11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index=1.0; root mean square error of approximation=0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management.
  
  
  CONCLUSIONS
  Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition.
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Electronic address: ercole.vellone@uniroma2.it.
authors.forename: Ercole
authors.initials: E
authors.lastname: Vellone
authors.affiliation: Department of Psychology, Sapienza University of Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fida
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: D'Agostino
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mottola
authors.affiliation: Faculty of Health Sciences, University San Jorge, Zaragoza, Spain.
authors.forename: Raul
authors.initials: R
authors.lastname: Juarez-Vela
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Alvaro
authors.affiliation: Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
mesh_terms: D000368:Aged; D003071:Cognition; D003072:Cognition Disorders; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D012648:Self Care / Q000523:psychology*
keywords: Cognition; Cross-sectional studies; Heart failure; Medication adherence; Mild cognitive impairment; Nursing theory; Self care; Self efficacy