title: The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure.
abstract: BACKGROUND
  Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.
  
  
  OBJECTIVE
  The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.
  
  
  METHODS
  A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.
  
  
  RESULTS
  Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support.
  
  
  CONCLUSIONS
  Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients' SM confidence.
authors.affiliation: Lufei Young, PhD, RN, APRN-NP Associate Professor, College of Nursing, Augusta University, Georgia. Kevin Kupzyk, PhD Assistant Professor, College of Nursing, University of Nebraska Medical Center, Omaha. Susan Barnason, PhD Assistant Professor, College of Nursing, University of Nebraska Medical Center, Lincoln.
authors.forename: Lufei
authors.initials: L
authors.lastname: Young
authors.forename: Kevin
authors.initials: K
authors.lastname: Kupzyk
authors.forename: Susan
authors.initials: S
authors.lastname: Barnason
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data*; D020377:Self Efficacy; D000073278:Self-Management / Q000379:methods / Q000523:psychology*; D012944:Social Support; D012959:Socioeconomic Factors; D014481:United States