title: Self-care in rural residents with heart failure: What we are missing.
abstract: As heart failure (HF) is a progressive, debilitating condition, life-long self-care is required to achieve good outcomes. Rural residents with HF encounter more challenges with adherence to self-care than their urban counterparts because of rural-urban inequalities related to socioeconomic resources and access to health care. To date, investigators have focused on self-care in HF patients in urban settings, although factors related to self-care may be different between rural and urban residents.
  
  
  
  The aim of this study was to explore the variables related to self-care in HF patients living in rural areas.
  
  
  
  A total of 580 patients in the USA were included in this analysis. We included 12 variables reflecting four aspects that affect patients' decisions to perform self-care: health literacy, psychosocial status, current symptom status, and aging status. We measured self-care using the European Heart Failure Self-Care Scale-9.
  
  
  
  Depressive symptoms (β = 0.28, 95% confidence interval (CI): 0.16 to 0.45), lower perceived control (β = -0.15, 95% CI: -0.32 to -0.08), better symptom status (β = -0.11, 95% CI: -0.13 to -0.003), and annual income of <$20,000 (β = 0.11, 95% CI: 0.38-2.97) were negatively associated with self-care in rural residents with HF. The model with 12 variables explained 7.1% of the variance in self-care.
  
  
  
  The variables included in the model did not sufficiently explain self-care among rural dwellers with HF. Given that all variables in the model were intrapersonal-level factors, more investigations that incorporate interpersonal factors (e.g. cultural beliefs and access to care) are needed in order to improve our understanding of self-care in HF patients living in rural areas.
authors: 1 Chungnam National University, College of Nursing, Daejeon, South Korea.
authors: Kyoung Suk
authors: KS
authors: Lee
authors: 2 University of Kentucky, College of Nursing, Lexington, KY, USA.
authors: Debra K
authors: DK
authors: Moser
authors: 3 University of California, San Francisco, School of Nursing, San Francisco, CA, USA.
authors: Michele M
authors: MM
authors: Pelter
authors: 4 University of California, School of Medicine Davis, Davis, CA USA.
authors: Thomas
authors: T
authors: Nesbitt
authors: 3 University of California, San Francisco, School of Nursing, San Francisco, CA, USA.
authors: Kathleen
authors: K
authors: Dracup
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Heart failure; rurality; self-care