title: Mechanism of engaging self-management behavior in rural heart failure patients.
abstract: OBJECTIVE
  The purpose of this study was to examine the relationships among self-efficacy, patient activation and SM in rural heart failure patients discharged from critical access hospitals.
  
  
  BACKGROUND
  Heart failure is one of the most disabling and resource-consuming chronic conditions. Compared to their urban counterparts, rural heart failure patients had higher healthcare utilizations and worse health outcomes. Self-management (SM) plays a significant role in improving patients' outcomes and reducing healthcare use. Despite persistent recommendations of SM, engagement in SM still remains low in rural heart failure patients. SM is a complex behavior, which is influenced by various factors. Evidence on the efficacy of interventions to promote SM is limited and inconsistent. One reason is that the mechanism of engagement of SM in the rural heart failure population has not been fully understood.
  
  
  METHODS
  A correlational study was conducted using secondary data from a randomized control trial aimed to improve SM adherence. Path analysis was used to test the hypothesis of patient activation mediating the effect of self-efficacy on SM.
  
  
  RESULTS
  Data were collected from a sample of 101 heart failure patients (37% males) with an average age of 70 years. The final model provided a good fit to the data, supporting the hypothesis that self-efficacy contributes to SM through activation.
  
  
  CONCLUSIONS
  The results of this study showed that effective SM interventions should be designed to include strategies to promote both self-efficacy and activation.
authors.affiliation: UNMC College of Nursing, Lincoln, NE, 68588-0220. Electronic address: lyoun1@unmc.edu.
authors.forename: Lufei
authors.initials: L
authors.lastname: Young
authors.affiliation: UNMC College of Nursing, Lincoln, NE, 68588-0220.
authors.forename: Susan
authors.initials: S
authors.lastname: Barnason
authors.affiliation: UNMC College of Nursing, Lincoln, NE, 68588-0220.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kupzyk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012648:Self Care
keywords: Heart failure; Patient activation; Rural health; Self-efficacy; Self-management