Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care
Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care
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DOI：
10.1016/j.ijnurstu.2015.06.018
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发表时间：
2015-11-01
影响因子：
8.1
通讯作者：
Vellone, Ercole
中科院分区：
文献类型：
--
作者：
Buck, Harleah G.;Dickson, Victoria Vaughan;Vellone, Ercole
背景：合并症与心衰患者自我护理的信心或自我效能降低有关，这反过来又会损害自我护理行为。合并症还与住院率增加和生活质量下降有关。然而，合并症和自我效能感相互作用影响自我护理、住院治疗和生活质量的方式尚不清楚。目的：本研究的目的是检验一个解释模型。研究问题是：(1)合并症对心力衰竭自我护理行为和结果（即住院、生活质量）的贡献是什么？(2)共病是否在自我效能感与心力衰竭自我护理行为的关系中起调节作用？设计：采用结构方程建模和简单斜率分析，对628例有症状的老年（平均年龄= 73，标准差(SD) = 11）男性（58%）意大利心力衰竭患者的现有数据集进行分析。结果：较高水平的自我护理维持与较高的生活质量和较低的住院率相关。较高的合并症水平与较低的自我保健管理水平相关。共病对自我效能感与自我护理维持的关系有调节作用，但对自我护理管理没有调节作用。事后简单坡度分析显示，坡度系数差异显著（pdiff < 0.05）。具体而言，在合并症较少的患者中，自我效能感与自我保健的关系明显强于合并症较高的患者。结论：自我效能感在各合并症水平的自我保健维持过程中起重要作用。由于较高的合并症削弱了自我效能感与自我护理维持之间的关系，针对不同程度的合并症，量身定制旨在提高自我效能感的干预措施可能是影响住院治疗和生活质量的关键。(C) 2015 Elsevier Ltd.版权所有。
Background: Comorbidity is associated with decreased confidence or self-efficacy to perform self-care in heart failure patients which, in turn, impairs self-care behaviors. Comorbidity is also associated with increased hospitalization rates and poorer quality of life. Yet the manner in which comorbidity and self-efficacy interact to influence self-care, hospitalization, and quality of life remains unclear.Objectives: The purpose of this study was to test an explanatory model. The research questions were (1) What is the contribution of comorbidity to heart failure self-care behaviors and outcomes (i.e. hospitalization, quality of life)? and (2) Is comorbidity a moderator of the relationship between self-efficacy and heart failure self-care behaviors?Design: This was an analysis of an existing dataset of 628 symptomatic, older (mean age = 73, standard deviation (SD) = 11) male (58%) Italian heart failure patients using structural equation modeling and simple slope analysis.Results: Higher levels of self-care maintenance were associated with higher quality of life and lower hospitalization rates. Higher levels of comorbidity were associated with lower levels of self-care management. Comorbidity moderated the relationship between self-efficacy and self-care maintenance, but not self-care management. Post hoc simple slopes analysis showed significantly different slope coefficients (pdiff < .05). Specifically, in patients with less comorbidity, the relationship between self-efficacy and self-care was significantly stronger than in patients with higher comorbidity.Conclusions: Self-efficacy is important in the self-care maintenance process at each level of comorbidity. Because higher comorbidity weakens the strength of the relationship between self-efficacy and self-care maintenance, tailoring interventions aimed at improving self-efficacy to different levels of comorbidity may be key to impacting hospitalization and quality of life. (C) 2015 Elsevier Ltd. All rights reserved.