Hammash Muna H, Crawford Timothy, Shawler Celeste, Schrader Melanie, Lin Chin-Yen, Shewekah Deena, Moser Debra K
1 School of Nursing, University of Louisville, USA.
2 College of Nursing, University of Kentucky, USA.
Eur J Cardiovasc Nurs. 2017 Oct;16(7):632-637. doi: 10.1177/1474515117705939. Epub 2017 Apr 26.
Adherence to treatment is crucial to improve outcomes in patients with heart failure. Good social support is associated with better adherence, but the mechanism for this association has not been well-explored.
The aim of this secondary analysis was to examine whether self-care confidence mediates the relationship between social support and treatment adherence in heart failure patients hospitalized with acute exacerbation.
A total of 157 inpatients with heart failure (63.5±13 years, 73% New York Heart Association class III/IV) were recruited from two hospitals located in urban areas in the USA. Participants completed the Self-Care of Heart Failure Index, the Multidimensional Perceived Social Support Scale, and the Medical Outcomes Study Specific Adherence Scale. A series of regression models were used to determine the mediation relationship.
Controlling for marital status and hospital site, social support was associated with adherence ( p=0.03). When self-confidence was included in the model, the effect of social support became non-significant, indicating full mediation of the relationship between social support and adherence by self-care confidence. The indirect effect (0.04) of social support on adherence through self-confidence was significant (95% confidence interval: 0.01-0.09).
Heart failure self-care confidence mediated the relationship between social support and treatment adherence. Thus interventions targeting patients' self-care confidence is essential to maximize patients' treatment adherence.
坚持治疗对于改善心力衰竭患者的预后至关重要。良好的社会支持与更好的依从性相关，但这种关联的机制尚未得到充分探索。
本二次分析的目的是检验自我护理信心是否介导了急性加重期住院心力衰竭患者社会支持与治疗依从性之间的关系。
从美国城市地区的两家医院招募了157名心力衰竭住院患者（63.5±13岁，73%为纽约心脏协会III/IV级）。参与者完成了心力衰竭自我护理指数、多维感知社会支持量表和医疗结果研究特定依从性量表。使用一系列回归模型来确定中介关系。
在控制婚姻状况和医院地点后，社会支持与依从性相关（p=0.03）。当将自我信心纳入模型时，社会支持的效应变得不显著，表明自我护理信心完全介导了社会支持与依从性之间的关系。社会支持通过自我信心对依从性的间接效应（0.04）显著（95%置信区间：0.01-0.09）。
心力衰竭自我护理信心介导了社会支持与治疗依从性之间的关系。因此，针对患者自我护理信心的干预措施对于最大限度地提高患者的治疗依从性至关重要。
