Young Lufei, Kupzyk Kevin, Barnason Susan
Lufei Young, PhD, RN, APRN-NP Associate Professor, College of Nursing, Augusta University, Georgia. Kevin Kupzyk, PhD Assistant Professor, College of Nursing, University of Nebraska Medical Center, Omaha. Susan Barnason, PhD Assistant Professor, College of Nursing, University of Nebraska Medical Center, Lincoln.
J Cardiovasc Nurs. 2017 Jul/Aug;32(4):E1-E8. doi: 10.1097/JCN.0000000000000390.
Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.
The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.
A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.
Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support.
Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients' SM confidence.
自我管理（SM）是心力衰竭（HF）管理的重要组成部分。改善自我管理行为的机制尚不清楚。
本研究的目的是检验患者激活是否介导自我效能对农村心力衰竭患者自我管理行为的影响。
使用从一项旨在改善自我管理行为的随机对照试验中收集的数据进行二次分析。主要变量包括自我管理知识、自我效能、患者激活和自我管理行为。
中介分析表明患者激活介导了自我效能对自我管理的影响。自我效能和患者激活分别与自我管理行为显著相关（r = 0.46，P <.001；β =.48，P =.001）。然而，当将患者激活纳入最终模型时，自我效能与自我管理行为不再直接相关（β =.17，P =.248）。自我管理知识和支持是显著的调节因素。在自我管理知识水平较高的患者中，患者激活并未介导自我效能对自我管理行为的影响（β =.15，P =.47）。当将自我管理支持纳入路径模型时，在自我管理支持水平高（β =.27，P =.27）或低（β =.27，P =.25）的情况下，患者激活在自我效能和自我管理行为之间不是显著的中介因素。
研究结果表明，针对自我管理知识和支持水平较低的高危心力衰竭患者提供有针对性的自我管理支持可能是有用的。此外，提高患者激活的策略可能会提高心力衰竭患者的自我管理信心。
