Self-care confidence may be more important than cognition to influence self-care behaviors in adults with heart failure: Testing a mediation model.
BACKGROUND
Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding.


OBJECTIVE
The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care.


METHODS
Secondary analysis of data from a descriptive study.


METHODS
Three out-patient sites in Pennsylvania and Delaware, USA.


METHODS
A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%).


METHODS
Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping.


RESULTS
Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929-.968; root mean squared error of approximation range: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care.


CONCLUSIONS
Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population.
Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy. Electronic address: ercole.vellone@uniroma2.it.
Ercole
E
Vellone
Department of Psychology, University of Milan - Bicocca, Milan, Italy.
Luca
L
Pancani
Department of Psychology, University of Milan - Bicocca, Milan, Italy.
Andrea
A
Greco
Department of Psychology, University of Milan - Bicocca, Milan, Italy.
Patrizia
P
Steca
Edith Clemmer Steinbright Professor of Gerontology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Barbara
B
Riegel
D000368:Aged; D002908:Chronic Disease; D003071:Cognition; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009483:Neuropsychological Tests; D012648:Self Care
Cognition; Heart failure; Mediation analysis; Self-care; Self-efficacy; Treatment adherence