Self-care confidence may be the key: A cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure

• DOI: 10.1016/j.ijnurstu.2015.06.013
• Publication Date: 2015-07-05T11:31:37Z
• Authors: Ercole Vellone; Roberta Fida; Fabio D’Agostino; Antonella Mottola; Raul Juarez-Vela; Rosaria Alvaro; Barbara Riegel
• Keywords: Male; 330; Self care; 150; Heart failure; CLINICHE E PEDIATRICHE; 03 medical and health sciences; Cognition; 0302 clinical medicine; Humans; Cross-sectional studie; Medication adherence; Aged; Heart Failure; 120; Settore MED/45 - SCIENZE INFERMIERISTICHE GENERALI; Mild cognitive impairment; CognitionCross-sectional studies; 3. Good health; Self Care; Self efficacy; Cross-Sectional Studies; Nursing theory; cognition; cross-sectional studies; heart failure; medication adherence; mild cognitive impairment; nursing theory; self care; self efficacy; Female; Cognition Disorders

Self-care, a key element of heart failure care, is challenging for patients with impaired cognition. Mechanisms through which cognitive impairment affects self-care are not currently well defined but evidence from other patient populations suggests that self-efficacy, or task-specific confidence, mediates the relationship between cognitive functioning and patient behaviors such as self-care.The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors.A secondary analysis of data from a cross-sectional study.Outpatient heart failure clinics in 28 Italian provinces.628 Italian heart failure patients.We used the Self-Care of Heart Failure Index v.6.2 to measure self-care maintenance, self-care management, and self-care confidence. Cognition was assessed with the Mini Mental State Examination. Structural equation modeling was used to analyze the data.Participants were 73 years old on average (SD=11), mostly (58%) male and mostly (77%) in New York Heart Association functional classes II and III. The mediation model showed excellent fit (comparative fit index=1.0; root mean square error of approximation=0.02): Self-care confidence totally mediated the relationship between cognition and self-care maintenance and management.Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failure patients with impaired cognition.