Rural dyadic collaboration in heart failure

Abstract

Background Dyads (patient/care partner) living with heart failure have shared responsibility for patient care. While theoretical and empirical literature regarding heart failure dyadic care is evolving rapidly, sociocultural contexts are unique and affect relationship dynamics. Yet, dynamics and underlying structures of rural dyadic collaboration in heart failure remains unknown. Purpose The purpose of this secondary analysis was to describe the dynamics and underlying structures of dyadic collaboration in heart failure among rural dyads. Methods A semi-structured interview was used to evaluate the acceptability and usefulness of a 12-week problem-solving intervention in addressing dyadic heart failure-related issues and the development of effective management strategies in week 5. Initially, in the qualitative analysis, an adjusted matrix analysis for each rural dyad was used to identify these dyadic issues and strategies. Subsequently, dynamics and underlying structures of collaboration occurring within these dyads in addressing these issues and strategies were analyzed and thematic codes generated. Finally, a multiple correspondence analysis of dyadic collaboration was performed within these thematic codes and a Benzécri equation used to normalize results, helping to determine the underlying structure and variance explained by the model on a Cartesian graph. Results Twenty-eight living in the rural southeastern U.S. were included. Patients were mostly Caucasian (73.3%), female (60%), married (70%), and college-educated (43%), with an average age of 67.7 years. Care partners were primarily women (n = 50%), Caucasian (82.1%), married (89.3%), and high school-educated (46.4%), with an average age of 64.5 years. Using inductive coding, four codes emerged regarding dyadic relational and collaborative aspects between dyads: role awareness, requesting or receiving help, and improving dyadic communication. XLStat was used for a multiple correspondence analysis (Fig. 1), with checking and then normalizing results using the Benzécri equation on R (Fig.2). There were two gender-determined patterns within dyads. In dyads in which the patient was female and the care partner male, communication improved, requests for assistance were verbalized, and there was an improvement in collaborative orientation. However, partners were unaware of their collaborative role. In contrast, when the care partner was a woman and the patient a man, communication and requests for help were implied, and there was no improvement in collaborative orientation. In this situation, partners had full role awareness. Conclusion(s) These findings suggest gender constitutes a key element in communication, verbalization of needs, and collaborative orientation within rural dyads living with heart failure. The importance of gender roles may be useful in designing future dyadic interventions for rural individuals with heart failure and their informal care partners.