Personal, Social and Clinical Factors Affecting Self-Care Maintenance and Management in People with Heart Failure

Abstract

Background

Heart failure affects over 6 million people in the US. It is characterized by distressing symptoms typically managed with medications, diet and monitoring. Self-care maintenance includes health-promoting behaviors such as taking medications, following medical recommendations and a specialized diet. Self-care management includes monitoring symptoms and acting when symptoms occur. Personal, social and clinical factors affect self-care maintenance and management behaviors; however, research findings are mixed about these relationships.

Aim

The aim of this study is to determine the influence of personal (age, education level and health literacy), social (marital status and social support) and clinical (NYHA, comorbidity index, and EF) factors on self-care maintenance and management.

Methods

Demographics (age, gender, education, marital status, socioeconomic status (SES), HYHA, ejection fraction (EF), comorbidity (Charlson Comorbidity Index (CCI), higher poor), social support (Strogatz Scale, 4-16, lower more support), self-care (SCHFI v6.2, maintenance and management 0-100, > 70 adequate), and health literacy (S-TOFHLA, 0-16 inadequate, 17-22 marginal, 23-36 adequate) were collected in a convenience sample of 116 people with HF admitted to a community hospital. Hierarchical regression explored the influence of personal (step 1: age, education, and health literacy), clinical (step 2: NYHA, EF, CCI) and social (step 3: social support and marital status) factors on levels of self-care maintenance and management.

Results

Subjects had a mean (Mn) age of 74.8+12.3 years and education of 11.9+3.7 years, 41% female, 60% married, and 46% reported having enough to make ends meet. Clinically, subjects had a Mn NYHA of 3 + 0.61, EF of 42.1+14.7, CCI of 3.0 +1.7. Mean social support was 6.1 + 3.8 and health literacy (46% inadequate, 16% marginal, 38% adequate). Self-care maintenance (Mn of 55.5 + 17) and management (Mn of 35 + 20.5) were inadequate. Women had higher EF and were older than males. Comorbidity (r = .22, p = .01) and EF (r = -.27, p = .002) were related to self-care management. Comorbidity (r= .17, p=.03) and literacy level (r= -.15, p = .05) were related to self-care maintenance. Self-care maintenance: Personal variables explained 4.7% of variance in self-care maintenance at step 1. Clinical variables accounted for 5.7% of the variance at step 2 and the addition of social support and marital status in step 3 added 2.1% for a total of 12.5 % explained variance for self-care maintenance overall. EF was the only significant predictor of self-care maintenance (p=.05). Self-care management: In the second regression equation, personal variables explained 4.2% of variance in self-care management at step 1. Clinical variables accounted for 6.3% of the variance at step 2 and the addition of social support and marital status in step 3 added 0.05% for a total of 11 % explained variance overall for self-care management. EF was the only significant predictor of self-care management (p=.04).

Conclusions

After controlling for personal and social factors, ejection fraction was the only predictor of self-care maintenance and management. Those with lower EF were younger males and likely had more symptoms. Clinicians should consider difficulty with self-care in older adults and those with higher EF.