J Cardiovasc Nurs. 2024;39(3):E93-E102. doi: 10.1097/JCN.0000000000001034. Epub 2023 Aug 11.
Inadequate self-care management has been reported in patients with heart failure (HF) and their family caregivers. However, evidence on the influencing factors and corresponding action paths for self-care management within a dyadic context is limited.
The aim of this study was to examine dyadic associations between benefit finding and self-care management in HF patient-caregiver dyads and the mediating role of mutuality in these associations.
This cross-sectional study was conducted in China, and a convenience sample of 253 HF patient-caregiver dyads was included in the analysis. Dyadic benefit finding and mutuality, patients' self-care management, and caregivers' contributions to self-care management were measured using self-reported questionnaires. The actor-partner interdependence model and actor-partner interdependence mediation model were adopted to analyze the data.
Patients' benefit finding had an actor effect on their own self-care management (β = 0.134, P < .05) and a partner effect on caregivers' contributions to self-care management (β = 0.130, P < .05). Similarly, caregivers' benefit finding had an actor effect on their contributions to self-care management (β = 0.316, P < .01) and a partner effect on patients' self-care management (β = 0.187, P < .01). Moreover, patients' mutuality completely mediated the actor effect of their benefit finding on self-care management (β = 0.127; 95% confidence interval, 0.032-0.233), and caregivers' mutuality partially mediated the actor effect of their benefit finding on contributions to self-care management (β = 0.060; 95% confidence interval, 0.012-0.124). In addition, caregivers' mutuality completely mediated the partner effect of patients' benefit finding on caregivers' contributions to self-care management (β = 0.036; 95% confidence interval, 0.009-0.081).
The findings revealed the importance of benefit finding and mutuality, 2 modifiable factors positively associated with dyadic HF self-care management. Dyadic interventions targeting on enhancing benefit finding and mutuality should be designed and implemented to improve HF self-care management.
心力衰竭（HF）患者及其家庭照顾者的自我护理管理不足。然而，在对偶情境下，关于自我护理管理的影响因素及其对应作用路径的证据有限。
本研究旨在检验 HF 患者-照顾者对偶中获益发现与自我护理管理之间的对偶关联，以及这些关联中互惠的中介作用。
本横断面研究在中国进行，分析了 253 对 HF 患者-照顾者。使用自我报告问卷测量对偶获益发现和互惠、患者自我护理管理以及照顾者对自我护理管理的贡献。采用演员-伙伴相互依存模型和演员-伙伴相互依存中介模型进行数据分析。
患者的获益发现对自身自我护理管理有演员效应（β=0.134，P<.05），对照顾者自我护理管理的贡献有伙伴效应（β=0.130，P<.05）。同样，照顾者的获益发现对其自我护理管理的贡献有演员效应（β=0.316，P<.01），对患者自我护理管理有伙伴效应（β=0.187，P<.01）。此外，患者的互惠完全中介了其获益发现对自我护理管理的演员效应（β=0.127；95%置信区间，0.032-0.233），照顾者的互惠部分中介了其获益发现对自我护理管理贡献的演员效应（β=0.060；95%置信区间，0.012-0.124）。此外，照顾者的互惠完全中介了患者获益发现对照顾者自我护理管理贡献的伙伴效应（β=0.036；95%置信区间，0.009-0.081）。
研究结果揭示了获益发现和互惠这 2 个与对偶 HF 自我护理管理呈正相关的可改变因素的重要性。应设计并实施针对增强获益发现和互惠的对偶干预措施，以改善 HF 自我护理管理。
