Ercole Vellone1, Luca Pancani2, Andrea Greco2, Patrizia Steca2, Barbara Riegel3. 1. Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy. Electronic address: ercole.vellone@uniroma2.it. 2. Department of Psychology, University of Milan - Bicocca, Milan, Italy. 3. Edith Clemmer Steinbright Professor of Gerontology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Abstract
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. OBJECTIVES: The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. DESIGN: Secondary analysis of data from a descriptive study. SETTINGS: Three out-patient sites in Pennsylvania and Delaware, USA. PARTICIPANTS: 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.
BACKGROUND:Cognitive impairment can reduce the self-care abilities of heart failurepatients. 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. OBJECTIVES: The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care. DESIGN: Secondary analysis of data from a descriptive study. SETTINGS: Three out-patient sites in Pennsylvania and Delaware, USA. PARTICIPANTS: 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.
Authors: Pavlos G Myserlis; Antonia Malli; Dimitrios K Kalaitzoglou; Grigorios Kalaitzidis; Michael Miligkos; Damianos G Kokkinidis; Andreas P Kalogeropoulos Journal: Heart Fail Rev Date: 2017-01 Impact factor: 4.214