Antecedents of self-care in adults with congenital heart defects.
BACKGROUND
Adults with congenital heart defects (ACHD) face long-term complications related to prior surgery, abnormal anatomy, and acquired cardiovascular conditions. Although self-care is an important part of chronic illness management, few studies have explored self-care in the ACHD population. The purpose of this study is to describe self-care and its antecedents in the ACHD population.


METHODS
Persons with moderate or severe ACHD (N=132) were recruited from a single ACHD center. Self-care (health maintenance behaviors, monitoring and management of symptoms), and potential antecedents including sociodemographic and clinical characteristics, ACHD knowledge, behavioral characteristics (depressive symptoms and self-efficacy), and family-related factors (parental overprotection and perceived family support) were collected via self-report and chart review. Multiple regression was used to identify antecedents of self-care maintenance, monitoring, and management.


RESULTS
Only 44.7%, 27.3%, and 23.3% of participants performed adequate levels of self-care maintenance, monitoring and management, respectively. In multiple regression analysis, self-efficacy, education, gender, perceived family support, and comorbidities explained 25% of the variance in self-care maintenance (R(2)=.248, F(5, 123)=9.44, p<.001). Age, depressive symptoms, self-efficacy, and NYHA Class explained 23% of the variance in self-care monitoring (R(2)=.232, F(2, 124)=10.66, p<.001). Self-efficacy and NYHA Class explained 9% of the variance in self-care management (R(2)=.094, F(2, 80)=5.27, p=.007).


CONCLUSIONS
Low levels of self-care are common among persons with ACHD. Multiple factors, including modifiable factors of self-efficacy, depressive symptoms, and perceived family support, are associated with self-care and should be considered in designing future interventions to improve outcomes in the ACHD population.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States. Electronic address: nmccabe@emory.edu.
Nancy
N
McCabe
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
Sandra B
SB
Dunbar
Cardiology Division, School of Medicine, Stony Brook University, Stony Brook, NY, United States.
Javed
J
Butler
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
Melinda
M
Higgins
Cardiology Division, School of Medicine, Emory University, Atlanta, GA, United States.
Wendy
W
Book
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
Carolyn
C
Reilly
D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D012648:Self Care / Q000379:methods*; D014481:United States
Adult congenital heart disease; Self-care; Self-management