Patient and caregiver contributions to self-care in multiple chronic conditions: A multilevel modelling analysis

Paolo Iovino; Karen S Lyons; Maddalena De Maria; Ercole Vellone; Davide Ausili; Christopher S Lee; Barbara Riegel; Maria Matarese

doi:10.1016/j.ijnurstu.2020.103574

Patient and caregiver contributions to self-care in multiple chronic conditions: A multilevel modelling analysis

Int J Nurs Stud. 2021 Apr:116:103574. doi: 10.1016/j.ijnurstu.2020.103574. Epub 2020 Mar 14.

Authors

Paolo Iovino¹, Karen S Lyons², Maddalena De Maria³, Ercole Vellone⁴, Davide Ausili⁵, Christopher S Lee⁶, Barbara Riegel⁷, Maria Matarese⁸

Affiliations

¹ University of Rome "Tor Vergata", Rome, Italy; Australian Catholic University, Melbourne, Australia. Electronic address: paolo.iovino@uniroma2.it.
² Boston College, MA, United States. Electronic address: karen.lyons@bc.edu.
³ University of Rome "Tor Vergata", Rome, Italy. Electronic address: maddalena.demaria@outlook.it.
⁴ University of Rome "Tor Vergata", Rome, Italy. Electronic address: ercole.vellone@uniroma2.it.
⁵ University of Milan-Bicocca, Monza, Italy. Electronic address: davide.ausili@unimib.it.
⁶ Boston College, MA, United States. Electronic address: leeddo@bc.edu.
⁷ University of Pennsylvania, Philadelphia, United States. Electronic address: briegel@nursing.upenn.edu.
⁸ Campus Bio-Medico University of Rome, Rome, Italy. Electronic address: m.matarese@unicampus.it.

PMID: 32276720
DOI: 10.1016/j.ijnurstu.2020.103574

Abstract

Background: Multiple chronic conditions (MCC) are highly prevalent worldwide, especially among older populations. Patient self-care and care partner (or caregiver) contributions to self-care are recommended to reduce the impact of MCC and improve patients' outcomes.

Objectives: To describe patient self-care and care partner contributions to self-care and to identify determinants of patient self-care and care partner contributions to self-care at the patient and care partner level.

Design: Multicentre cross-sectional study.

Setting: Outpatient and community settings in Italy.

Participants: A sample of 340 patients with MCC and care partner dyads was recruited between 2017 and 2018.

Methods: We measured patient's self-care and care partner contributions to self-care in dyads using the Self-care of Chronic Illness Inventory and the Caregiver Contribution to Self-care of Chronic Illness Inventory. To control for dyadic interdependence, we performed a multilevel modelling analysis.

Results: Patients' and care partners' mean ages were 76.65 (± 7.27) and 54.32 (± 15.25), respectively. Most care partners were female and adult children or grandchildren. The most prevalent chronic conditions in patients were diabetes (74%) and heart failure (34%). Patients and care partners reported higher levels of self-care monitoring than self-care maintenance and management behaviours. Important patient clinical determinants of self-care included cognitive status, number of medications and type of chronic condition. Care partner determinants of self-care contributions included age, gender, education, perceived income, care partner burden, caregiving hours per week and the presence of a secondary care partner.

Conclusions: Our findings support the importance of taking a dyadic approach when focusing on patients with MCC and their care partners. More dyadic longitudinal research is recommended to reveal the modifiable determinants of self-care and the complex relationships between patients and care partners in the context of MCC.

Keywords: Caregivers; Determinants; Dyads; Multiple chronic conditions; Older people; Self-care.

Publication types

Multicenter Study

MeSH terms

Adult
Caregivers*
Child
Cross-Sectional Studies
Female
Heart Failure*
Humans
Italy
Quality of Life
Self Care