Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care

Harleah G Buck; Victoria Vaughan Dickson; Roberta Fida; Barbara Riegel; Fabio D'Agostino; Rosaria Alvaro; Ercole Vellone

doi:10.1016/j.ijnurstu.2015.06.018

Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care

Int J Nurs Stud. 2015 Nov;52(11):1714-22. doi: 10.1016/j.ijnurstu.2015.06.018. Epub 2015 Jul 17.

Authors

Harleah G Buck¹, Victoria Vaughan Dickson², Roberta Fida³, Barbara Riegel⁴, Fabio D'Agostino⁵, Rosaria Alvaro⁵, Ercole Vellone⁵

Affiliations

¹ College of Nursing, Penn State University, 201 Health and Human Development East, University Park, PA 16802, USA. Electronic address: hgb2@psu.edu.
² College of Nursing, New York University, New York, NY, USA.
³ Department of Psychology, Sapienza University of Rome, Rome, Italy.
⁴ School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.

PMID: 26234935
DOI: 10.1016/j.ijnurstu.2015.06.018

Abstract

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.

Keywords: Comorbidity; Explanatory model; Heart failure; Self-care; Self-efficacy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Comorbidity*
Heart Failure / psychology*
Hospitalization*
Humans
Male
Models, Theoretical
Quality of Life*
Self Care*
Self Efficacy*