J Cardiovasc Nurs. 2024;39(3):255-265. doi: 10.1097/JCN.0000000000001024. Epub 2023 Aug 8.
Patients with heart failure experience high symptom burden, which can be mitigated with adequate self-care. Caregiver contribution to self-care has been theorized to improve patient symptom burden. The mediating role of patient self-care in this relationship has not been tested yet.
The aim of this study was to test whether ( a ) caregiver contribution to self-care influences patient self-care, ( b ) patient self-care influences symptom burden, and ( c ) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden.
In this study, the authors conducted a secondary analysis of the baseline and 3-month data from the MOTIVATE-HF trial, which enrolled 510 dyads (patient with heart failure and caregiver) in Italy. Multigroup confirmatory factor analysis was used to test measurement invariance. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test our hypotheses.
On average, caregivers were 54 years old and mainly female, whereas patients were 72.4 years old and mainly male. Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β = 0.280, P < .001), which, in turn, was associated with lower symptom burden (β = -0.280, P < .001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β = -0.079; 95% bias-corrected bootstrapped confidence interval, -0.130 to -0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β = 0.238, P = .006). The model significantly accounted for 37% of the total variance in symptom burden scores ( P < .001).
This study expands the situation-specific theory of caregiver contribution to heart failure self-care and provides new evidence on the role of caregiver contribution to self-care and patient self-care on symptom burden in heart failure.
心力衰竭患者的症状负担较高，通过充分的自我护理可以减轻这种负担。有理论认为，照顾者对自我护理的贡献可以改善患者的症状负担。然而，这种关系中患者自我护理的中介作用尚未得到验证。
本研究旨在检验：（a）照顾者对自我护理的贡献是否会影响患者的自我护理；（b）患者的自我护理是否会影响症状负担；以及（c）患者的自我护理是否在照顾者对自我护理的贡献与症状负担之间起中介作用。
本研究对意大利进行的 MOTIVATE-HF 试验的基线和 3 个月数据进行了二次分析，共纳入 510 对患者（心力衰竭患者和照顾者）。采用多组验证性因素分析检验测量不变性。采用同期中介的自回归纵向路径分析检验我们的假设。
平均而言，照顾者年龄为 54 岁，主要为女性，而患者年龄为 72.4 岁，主要为男性。照顾者对自我护理维持的贡献越好，患者的自我护理维持越好（β=0.280，P<.001），而患者的自我护理维持与症状负担呈负相关（β=-0.280，P<.001）。患者的自我护理维持在照顾者对自我护理维持的影响与症状负担之间起中介作用（β=-0.079；95%偏倚校正的自举置信区间为-0.130 至-0.043）。照顾者对自我护理管理的贡献越好，患者的自我护理管理也越好（β=0.238，P=.006）。该模型对症状负担评分的总方差有 37%的解释力（P<.001）。
本研究扩展了针对心力衰竭自我护理的照顾者贡献的特定情境理论，并提供了关于照顾者对自我护理的贡献和患者自我护理对心力衰竭症状负担的作用的新证据。
