title: Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care.
abstract: BACKGROUND
  Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in heart failure patients which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization rates and poorer quality of life. Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and quality of life remains unclear.
  
  
  OBJECTIVE
  The purpose of this study was to test an explanatory model. The research questions were (1) What is the contribution of comorbidity to heart failure self-care behaviors and outcomes (i.e. hospitalization, quality of life)? and (2) Is comorbidity a moderator of the relationship between self-efficacy and heart failure self-care behaviors?
  
  
  METHODS
  This was an analysis of an existing dataset of 628 symptomatic, older (mean age=73, standard deviation (SD)=11) male (58%) Italian heart failure patients using structural equation modeling and simple slope analysis.
  
  
  RESULTS
  Higher levels of self-care maintenance were associated with higher quality of life and lower hospitalization rates. Higher levels of comorbidity were associated with lower levels of self-care management. Comorbidity moderated the relationship between self-efficacy and self-care maintenance, but not self-care management. Post hoc simple slopes analysis showed significantly different slope coefficients (pdiff<.05). Specifically, in patients with less comorbidity, the relationship between self-efficacy and self-care was significantly stronger than in patients with higher comorbidity.
  
  
  CONCLUSIONS
  Self-efficacy is important in the self-care maintenance process at each level of comorbidity. Because higher comorbidity weakens the strength of the relationship between self-efficacy and self-care maintenance, tailoring interventions aimed at improving self-efficacy to different levels of comorbidity may be key to impacting hospitalization and quality of life.
authors.affiliation: College of Nursing, Penn State University, 201 Health and Human Development East, University Park, PA 16802, USA. Electronic address: hgb2@psu.edu.
authors.forename: Harleah G
authors.initials: HG
authors.lastname: Buck
authors.affiliation: College of Nursing, New York University, New York, NY, USA.
authors.forename: Victoria Vaughan
authors.initials: VV
authors.lastname: Dickson
authors.affiliation: Department of Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Fida
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
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: Rosaria
authors.initials: R
authors.lastname: Alvaro
authors.affiliation: Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Ercole
authors.initials: E
authors.lastname: Vellone
mesh_terms: D000368:Aged; D015897:Comorbidity; D006333:Heart Failure / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy
keywords: Comorbidity; Explanatory model; Heart failure; Self-care; Self-efficacy