Vellone Ercole, Pancani Luca, Greco Andrea, Steca Patrizia, Riegel Barbara
Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.
Department of Psychology, University of Milan - Bicocca, Milan, Italy.
Int J Nurs Stud. 2016 Aug;60:191-9. doi: 10.1016/j.ijnurstu.2016.04.016. Epub 2016 Apr 30.
Cognitive impairment can reduce the self-care abilities of heart failure patients. Theory and preliminary evidence suggest that self-care confidence may mediate the relationship between cognition and self-care, but further study is needed to validate this finding.
The aim of this study was to test the mediating role of self-care confidence between specific cognitive domains and heart failure self-care.
Secondary analysis of data from a descriptive study.
Three out-patient sites in Pennsylvania and Delaware, USA.
A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%).
Data on heart failure self-care and self-care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping.
Most participants had at least 1 impaired cognitive domain. In mediation models, self-care confidence consistently influenced self-care and totally mediated the relationship between simple attention and self-care and between working memory and self-care (comparative fit index range: .929-.968; root mean squared error of approximation range: .032-.052). Except for short-term memory, which had a direct effect on self-care maintenance, the other cognitive domains were unrelated to self-care.
Self-care confidence appears to be an important factor influencing heart failure self-care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve self-care in this population.
认知障碍会降低心力衰竭患者的自我护理能力。理论和初步证据表明，自我护理信心可能在认知与自我护理之间的关系中起中介作用，但需要进一步研究来验证这一发现。
本研究旨在检验自我护理信心在特定认知领域与心力衰竭自我护理之间的中介作用。
对一项描述性研究的数据进行二次分析。
美国宾夕法尼亚州和特拉华州的三个门诊地点。
280名成年慢性心力衰竭患者的样本，平均年龄62岁，大多数为男性（64.3%）。
使用心力衰竭自我护理指数6.2收集心力衰竭自我护理和自我护理信心的数据。由经过培训的研究助理使用神经心理测试组合收集认知数据，该测试组合测量简单和复杂注意力、处理速度、工作记忆和短期记忆。通过自我报告收集社会人口统计学数据。从病历中提取临床信息。采用结构方程模型进行中介分析，通过自抽样评估间接效应。
大多数参与者至少有一个认知领域受损。在中介模型中，自我护理信心始终影响自我护理，并完全中介了简单注意力与自我护理之间以及工作记忆与自我护理之间的关系（比较拟合指数范围：.929-.968；近似均方根误差范围：.032-.052）。除短期记忆对自我护理维持有直接影响外，其他认知领域与自我护理无关。
即使在认知受损的患者中，自我护理信心似乎也是影响心力衰竭自我护理的一个重要因素。由于很少有研究成功改善认知功能，可以考虑将增强信心的干预措施作为改善该人群自我护理的一种方法。
