Vaughan Dickson, V., Buck, H. G & Riegel, B. (2013). Multiple comorbid conditions challenge heart failure self-care by decreasing self-efficacy. Nursing Research,62(1), 2-9. United States: Lippincott Williams & Wilkins. Retrieved from https://doi.org/10.1097/NNR.0b013e31827337b3
Background: Most heart failure patients have multiple comorbidities. Objective: This study aims to test the moderating effect of comorbidity on the relationship between self-efficacy and self-care in adults with heart failure. Methods: Secondary analysis of four mixed methods studies ( n = 114 ) was done. Self-care and self-efficacy were measured using the Self-Care of Heart Failure Index. Comorbidity was measured with the Charlson Comorbidity Index. Parametric statistics were used to examine the relationships among self-efficacy, self-care, and the moderating influence of comorbidity. Qualitative data yielded themes about self-efficacy in self-care and explained the influence of comorbidity on self-care. Results: Most ( 79% ) reported two or more comorbidities. There was a significant relationship between self-care and the number of comorbidities ( r = -.25; p = .03 ). There were significant differences in self-care by comorbidity level ( self-care maintenance, F[1, 112], 5.96, p = .019, and self-care management, F[1, 72], 4.66, p = .034 ). Using moderator analysis of the effect of comorbidity on self-efficacy and self-care, a significant effect was found only in self-care maintenance among those who had moderate levels of comorbidity ( b = .620, p = .022, Fchange df[6,48], 5.61, p = .022 ). In the qualitative data, self-efficacy emerged as an important variable influencing self-care by shaping how individuals prioritized and integrated multiple and often competing self-care instructions. Discussion: Comorbidity influences the relationship between self-efficacy and self-care maintenance, but only when levels of comorbidity are moderately high. Methods of improving self-efficacy may improve self-care in those with multiple comorbidities.
Mary MacKillop Institute for Health Research
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