Ercole Vellone1, Roberta Fida2, Fabio D'Agostino3, Antonella Mottola3, Raul Juarez-Vela4, Rosaria Alvaro3, Barbara Riegel5. 1. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. Electronic address: ercole.vellone@uniroma2.it. 2. Department of Psychology, Sapienza University of Rome, Italy. 3. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. 4. Faculty of Health Sciences, University San Jorge, Zaragoza, Spain. 5. Edith Clemmer Steinbright Chair of Gerontology, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: 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. OBJECTIVE: The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. DESIGN: A secondary analysis of data from a cross-sectional study. SETTING: Outpatient heart failure clinics in 28 Italian provinces. PARTICIPANTS: 628 Italian heart failure patients. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. OBJECTIVE: The aim of this study was to test the mediating role of self-care confidence in the relationship between cognition and self-care behaviors. DESIGN: A secondary analysis of data from a cross-sectional study. SETTING:Outpatientheart failure clinics in 28 Italian provinces. PARTICIPANTS: 628 Italian heart failurepatients. METHODS: 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. RESULTS: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. CONCLUSION: Cognition affects self-care behaviors indirectly, through self-care confidence. Interventions aimed at improving self-care confidence may improve self-care, even in heart failurepatients with impaired cognition.