Assistant Dean and Associate Professor, Cedarville University School of Pharmacy, 251N. Main St., Cedarville, OH 45314, USA.
Professor Emerita, Purdue University, School of Nursing, 502N. University Street, West Lafayette, IN, 47907, USA.
Heart Lung. 2020 Nov-Dec;49(6):702-708. doi: 10.1016/j.hrtlng.2020.08.004. Epub 2020 Aug 28.
Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood.
The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care.
Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis.
Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized.
Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.
健康素养不足和心力衰竭的患者面临着更高的医疗成本、更多的住院治疗和更高的死亡率。为了应对这些负面影响，患者需要改善心力衰竭自我护理。多种因素可能会影响自我护理，但它们的确切作用模式尚不完全清楚。
本研究旨在考察一个模型，该模型探讨了健康素养、抑郁、疾病知识和自我效能感对心力衰竭自我护理表现的贡献。
采用横断面设计，从心力衰竭诊所招募患者，并完成认知、健康素养、抑郁、知识、自我效能和自我护理的验证评估。根据健康素养水平将患者分为两组：不足/边缘和充足。采用独立 t 检验评估组间差异。采用观察变量路径分析估计并检验假设路径和中介关系。
参与者（n=100）主要为男性（67%）、白人（93%），至少受过高中教育（85%）。健康素养与疾病知识相关（路径系数=0.346，p=0.002），抑郁与自我效能呈负相关（路径系数=-0.211，p=0.037），自我效能与自我护理呈正相关（路径系数=0.402，p<0.0005），且有证据表明自我效能在抑郁与自我护理之间起中介作用。没有证据表明：知识或自我效能在健康素养与自我护理之间起中介作用；知识与自我效能或自我护理之间存在正相关；或自我效能在疾病知识与自我护理关系中起中介作用。此外，抑郁与自我护理的关系是间接的，而不是假设的直接关系。
自我效能和抑郁与心力衰竭自我护理相关。该模型产生的数据表明，医疗保健专业人员应积极与所有患者接触，以获得自我效能并解决抑郁问题，从而积极影响心力衰竭自我护理。
