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Barbara Riegel - One of the best experts on this subject based on the ideXlab platform.
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patient and caregiver contributions to self care in multiple chronic conditions a multilevel modelling analysis
International Journal of Nursing Studies, 2020Co-Authors: Davide Ausili, Paolo Iovino, Karen S Lyons, Maddalena De Maria, Ercole Vellone, Christopher S Lee, Barbara Riegel, Maria MatareseAbstract:Abstract Background Multiple chronic conditions (MCC) are highly prevalent worldwide, especially among older populations. Patient Self-Care and care partner (or caregiver) contributions to Self-Care are recommended to reduce the impact of MCC and improve patients’ outcomes. Objectives To describe patient Self-Care and care partner contributions to Self-Care and to identify determinants of patient Self-Care and care partner contributions to Self-Care at the patient and care partner level. Design Multicentre cross-sectional study. Setting Outpatient and community settings in Italy. Participants A sample of 340 patients with MCC and care partner dyads was recruited between 2017 and 2018. Methods We measured patient’s Self-Care and care partner contributions to Self-Care in dyads using the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory. To control for dyadic interdependence, we performed a multilevel modelling analysis. Results Patients’ and care partners’ mean ages were 76.65 (± 7.27) and 54.32 (± 15.25), respectively. Most care partners were female and adult children or grandchildren. The most prevalent chronic conditions in patients were diabetes (74%) and heart failure (34%). Patients and care partners reported higher levels of Self-Care monitoring than Self-Care maintenance and management behaviours. Important patient clinical determinants of Self-Care included cognitive status, number of medications and type of chronic condition. Care partner determinants of Self-Care contributions included age, gender, education, perceived income, care partner burden, caregiving hours per week and the presence of a secondary care partner. Conclusions Our findings support the importance of taking a dyadic approach when focusing on patients with MCC and their care partners. More dyadic longitudinal research is recommended to reveal the modifiable determinants of Self-Care and the complex relationships between patients and care partners in the context of MCC.
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Abstract 20468: Self-Care Confidence Moderates the Relationship Between Marginalization and Self-Care Maintenance in Heart Failure Patients
Circulation, 2017Co-Authors: Foster Osei Baah, Debra K. Moser, Marguerite Daus, Kristen A. Sethares, Onome Osokpo, Jennifer C. Miller, Barbara RiegelAbstract:Background: Marginalized individuals in society are less motivated to care for themselves. Adequate Self-Care behavior is known to improve outcomes in patients with heart failure (HF), but the relationship between marginality and Self-Care has not been explored. Prior research suggests Self-Care confidence can influence Self-Care behavior. Methods: We enrolled 287 community-living adults with any type of HF from inpatient settings and outpatient clinics in four northeastern and southern cities in the US and via an online national clinical research registry, ResearchMatch.com. Demographic data were used to calculate marginality scores as the sum of 3 variables: race (white, other, black), education (college, trade school, high school), and income adequacy (more than enough, enough, less than enough) for 9 total points; higher scores indicate higher marginality. All completed the Self-Care of HF Index (SCHFI v7.1). We used Self-Care maintenance (reflects Self-Care behavior) and Self-Care confidence scales in the analysis. All SCHFI scale scores were standardized (0-100). Higher scores indicate better Self-Care and higher Self-Care confidence. Standard mediator and moderator analyses were performed. Results: The sample was mainly white (78%), male (68%), with a mean age 62±13.5. We regressed Self-Care maintenance on marginality. There was a weak negative linear correlation (r = - 0.15, p Conclusion: HF patients in marginalized groups are at risk for poor Self-Care maintenance, but this association is moderated by Self-Care confidence. Interventions that augment Self-Care confidence may be particularly important in marginalized groups.
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self care confidence may be more important than cognition to influence self care behaviors in adults with heart failure testing a mediation model
International Journal of Nursing Studies, 2016Co-Authors: Ercole Vellone, L Pancani, A Greco, P Steca, Barbara RiegelAbstract:Abstract Background Cognitive impairment can reduce the Self-Care abilities of heart failure patients. Theory and preliminary evidence suggest that Self-Care confidence may mediate the relationship between cognition and Self-Care, but further study is needed to validate this finding. Objectives The aim of this study was to test the mediating role of Self-Care confidence between specific cognitive domains and heart failure Self-Care. Design Secondary analysis of data from a descriptive study. Settings Three out-patient sites in Pennsylvania and Delaware, USA. Participants A sample of 280 adults with chronic heart failure, 62 years old on average and mostly male (64.3%). Methods Data on heart failure Self-Care and Self-Care confidence were collected with the Self-Care of Heart Failure Index 6.2. Data on cognition were collected by trained research assistants using a neuropsychological test battery measuring simple and complex attention, processing speed, working memory, and short-term memory. Sociodemographic data were collected by self-report. Clinical information was abstracted from the medical record. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping. Results Most participants had at least 1 impaired cognitive domain. In mediation models, Self-Care confidence consistently influenced Self-Care and totally mediated the relationship between simple attention and Self-Care and between working memory and Self-Care (comparative fit index range: .929–.968; root mean squared error of approximation range: .032–.052). Except for short-term memory, which had a direct effect on Self-Care maintenance, the other cognitive domains were unrelated to Self-Care. Conclusions Self-Care confidence appears to be an important factor influencing heart failure Self-Care even in patients with impaired cognition. As few studies have successfully improved cognition, interventions addressing confidence should be considered as a way to improve Self-Care in this population.
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Describing Self-Care in Italian adults with heart failure and identifying determinants of poor Self-Care
European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 2013Co-Authors: Antonello Cocchieri, Barbara Riegel, Rosaria Alvaro, Roberta Fida, Gennaro Rocco, Fabio D'agostino, Ercole VelloneAbstract:Background: Self-Care improves outcomes in patients with heart failure; however, no studies have been conducted on this topic in Italy. Aims: We aimed to describe Self-Care in Italian adults with heart failure and to identify sociodemographic and clinical determinants of Self-Care. Methods: A cross-sectional design was used to study 1192 heart failure patients enrolled across Italy. We measured Self-Care using the Self-Care of Heart Failure Index version 6.2, which measures Self-Care maintenance, management and confidence. Sociodemographic and clinical data were tested as potential determinants of Self-Care. Results: The mean age of the sample was 72 (SD = 11) years; 58% were male. In the three areas of Self-Care, scores ranged from 53.18 to 55.26 and few people were adequate in Self-Care (14.5% to 24.4% of the sample). Self-Care behaviours particularly low in this population were symptom monitoring, exercise, use of reminders to take medicines and symptom recognition. Confidence in the ability to keep oneself free of symptoms and relieve symptoms was low. Taking fewer medications, poor cognition, older age, having a caregiver, being male and having heart failure for a shorter time predicted poor Self-Care maintenance. Poor cognition, not being employed, being male, and having worse New York Heart Association class predicted poor Self-Care management. Poor cognition, taking fewer mediations, older age, and male gender predicted poor Self-Care confidence. Conclusion: Self-Care is poor in Italian heart failure patients. Determinants of poor Self-Care identified in this study can help to target patients’ education. Male gender and poor cognition were consistently associated with poor Self-Care maintenance, management and confidence.
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Abstract 16531: Self-Care Confidence Mediates the Relationship Between Cognition and Self-Care Behaviors in Adults With Heart Failure
Circulation, 2013Co-Authors: Ercole Vellone, Rosaria Alvaro, Roberta Fida, Gennaro Rocco, Carlo F Spatola, Antonello Cocchieri, Barbara RiegelAbstract:Background: Confidence in the ability to perform Self-Care is a powerful predictor of behavior. Little is known about factors associated with HF Self-Care confidence. We hypothesized that subtle levels of cognitive impairment decrease Self-Care confidence and thereby impair HF Self-Care. The aim was to test the mediating role of Self-Care confidence in the relationship between cognition and Self-Care behaviors. Methods: A descriptive study was conducted with a convenience sample of 628 patients with a confirmed diagnosis of chronic HF. Participants were selected from 24 cardiovascular centers across Italy if they were >18 years old and stable for the past 3 months. Self-Care maintenance, management and confidence were measured with the Self-Care of Heart Failure Index (SCHFI v.6.2) (0-100, higher score=better Self-Care). Cognition was measured with the Mini Mental State Examination (MMSE, 0-30, higher score=better cognition). Structural equation modeling was used to test the mediating role of Self-Care confidence in the relationship between cognition and Self-Care maintenance and management. Results: Participants were mean age 73 years (SD 11), 58% male, 77% NYHA class II/III, mean ejection fraction 43%. Self-Care was poor (mean score range 53 to 55). Mean MMSE was 23 (SD 6.3) or slightly impaired. The specified model fit adequately: χ2(1) = 1.825, p=.18; CFI=1.00; TLI=.99; RMSEA=.036 (CI=.000 - .120), p=.47; SRMR=.012. Self-Care confidence totally mediated the relationship between MMSE and Self-Care maintenance and partially mediated the relationship between MMSE and Self-Care management even though management was explained mostly by confidence and not MMSE (Figure). Conclusion: One mechanism by which cognition influences Self-Care appears to be through its effect on Self-Care confidence. Interventions aimed at improving Self-Care confidence may be useful in improving HF Self-Care behaviors in patients with mild cognitive impairment. ![Graphic][1] [1]: /embed/inline-graphic-1.gif
Gale G Whiteneck - One of the best experts on this subject based on the ideXlab platform.
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self managed versus agency provided personal assistance care for individuals with high level tetraplegia
Archives of Physical Medicine and Rehabilitation, 1995Co-Authors: Jane Mattson Prince, Scott M Manley, Gale G WhiteneckAbstract:Abstract Objective: To determine whether a finite population, with severe physical disability, had better perceived quality of life, health status, and lower cost depending on whether they used agencies for their caregivers or hired, trained, and reimbursed their caregivers, independently. Design and Setting: A survey, including demographics and portions of the Rand-36, LSI-A, PASI, PIP and CHART. The interviews were completed by telephone, by the leading author. Participants: Seventy-one persons who had sustained spinal cord lesions between C1 and C4. All were at least 1 year postinjury and had received rehabilitation at a local hospital in Englewood, Colorado. Ten additional persons came from the leading author's case management caseload or from a Boston rehabilitation center. They were interviewed in person for pretesting. Main Outcome Measures: Chi square, t tests, and multiple regression analysis, which controlled for potentially confounding group differences. Individuals were placed in two cohorts. Twenty-nine persons received primarily agency provided care and 42 individuals used personal care attendants. Results:> The self-managed group showed significantly better health outcomes, with fewer rehospitalizations and diminished preventable complications. They also experienced greater life satisfaction and significantly lower costs. Those in the self-managed care group had significantly higher composite scores on Rand-36, indicating higher perception of recent health status. Significant differences in mean PIP scores indicated that members of the self-managed care cohort perceived greater control over day-to-day lives. PASI scores showed that persons in this cohort had greater satisfaction with their caregivers and costs. Cost benefit analysis showed appreciable lowering of costs in the self-managed care group. Conclusions: The self-managed care group had many more hours of paid attendant care, whereas the agency provider group had almost equal amounts of care from paid and unpaid providers. Persons using self-managed care reported having fewer medical problems, fewer hospitalizations and better perception of health. Participants declared greater satisfaction in having a choice of caregivers. Persons who were self-managing their care spent less money and used more hours of paid care. The financial burden borne both by the individual and society and the emotional burden borne by families and friends were diminished by the persons managing their care individually.
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self managed versus agency provided personal assistance care for individuals with high level tetraplegia
Archives of Physical Medicine and Rehabilitation, 1995Co-Authors: Jane Mattson Prince, Scott M Manley, Gale G WhiteneckAbstract:Abstract Objective: To determine whether a finite population, with severe physical disability, had better perceived quality of life, health status, and lower cost depending on whether they used agencies for their caregivers or hired, trained, and reimbursed their caregivers, independently. Design and Setting: A survey, including demographics and portions of the Rand-36, LSI-A, PASI, PIP and CHART. The interviews were completed by telephone, by the leading author. Participants: Seventy-one persons who had sustained spinal cord lesions between C1 and C4. All were at least 1 year postinjury and had received rehabilitation at a local hospital in Englewood, Colorado. Ten additional persons came from the leading author's case management caseload or from a Boston rehabilitation center. They were interviewed in person for pretesting. Main Outcome Measures: Chi square, t tests, and multiple regression analysis, which controlled for potentially confounding group differences. Individuals were placed in two cohorts. Twenty-nine persons received primarily agency provided care and 42 individuals used personal care attendants. Results:> The self-managed group showed significantly better health outcomes, with fewer rehospitalizations and diminished preventable complications. They also experienced greater life satisfaction and significantly lower costs. Those in the self-managed care group had significantly higher composite scores on Rand-36, indicating higher perception of recent health status. Significant differences in mean PIP scores indicated that members of the self-managed care cohort perceived greater control over day-to-day lives. PASI scores showed that persons in this cohort had greater satisfaction with their caregivers and costs. Cost benefit analysis showed appreciable lowering of costs in the self-managed care group. Conclusions: The self-managed care group had many more hours of paid attendant care, whereas the agency provider group had almost equal amounts of care from paid and unpaid providers. Persons using self-managed care reported having fewer medical problems, fewer hospitalizations and better perception of health. Participants declared greater satisfaction in having a choice of caregivers. Persons who were self-managing their care spent less money and used more hours of paid care. The financial burden borne both by the individual and society and the emotional burden borne by families and friends were diminished by the persons managing their care individually.
Davide Ausili - One of the best experts on this subject based on the ideXlab platform.
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How do Self-Care maintenance, Self-Care monitoring, and Self-Care management affect glycated haemoglobin in adults with type 2 diabetes? A multicentre observational study
Endocrine, 2020Co-Authors: Diletta Fabrizi, Paola Rebora, Michela Luciani, Stefania Di Mauro, Maria Grazia Valsecchi, Davide AusiliAbstract:Purpose To evaluate how Self-Care maintenance, Self-Care monitoring, and Self-Care management affect glycated haemoglobin in type 2 diabetes mellitus patients and to set cut-off points of the Self-Care of Diabetes Inventory scales using glycated haemoglobin as outcome of interest. Methods A secondary analysis of a previous multicentre observational cross-sectional study was conducted. Overall, 540 adults with type 2 diabetes mellitus confirmed diagnosis were involved. Socio-demographic and clinical data were collected. Self-Care maintenance, Self-Care monitoring, and Self-Care management were measured by the Self-Care of Diabetes Inventory. Linear regression models were performed to assess the relationship between Self-Care maintenance, Self-Care monitoring, and Self-Care management and glycated haemoglobin. Receiver operating characteristics curves were carried out to identify the best cut-off score for each Self-Care scale considering glycated haemoglobin >7% as outcome of interest. Results Self-Care monitoring and Self-Care management were associated to glycated haemoglobin in both patients without (Self-Care monitoring p = 0.0008; Self-Care management p = 0.0178) and with insulin therapy (Self-Care monitoring p = 0.0007; Self-Care management p = 0.0224). Self-Care maintenance was associated to glycated haemoglobin in patients without insulin therapy ( p = 0.0118). Cut-off scores providing the best performance were 70 points for Self-Care maintenance and Self-Care monitoring, and 60 points for Self-Care management. Conclusions Self-Care maintenance, Self-Care monitoring, and Self-Care management differently affect glycated haemoglobin in patients with type 2 diabetes mellitus. Clinicians could implement tailored interventions to improve glycaemic control considering the lacking area of Self-Care.
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How do Self-Care maintenance, Self-Care monitoring, and Self-Care management affect glycated haemoglobin in adults with type 2 diabetes? A multicentre observational study.
Endocrine, 2020Co-Authors: Diletta Fabrizi, Paola Rebora, Michela Luciani, Stefania Di Mauro, Maria Grazia Valsecchi, Davide AusiliAbstract:To evaluate how Self-Care maintenance, Self-Care monitoring, and Self-Care management affect glycated haemoglobin in type 2 diabetes mellitus patients and to set cut-off points of the Self-Care of Diabetes Inventory scales using glycated haemoglobin as outcome of interest. A secondary analysis of a previous multicentre observational cross-sectional study was conducted. Overall, 540 adults with type 2 diabetes mellitus confirmed diagnosis were involved. Socio-demographic and clinical data were collected. Self-Care maintenance, Self-Care monitoring, and Self-Care management were measured by the Self-Care of Diabetes Inventory. Linear regression models were performed to assess the relationship between Self-Care maintenance, Self-Care monitoring, and Self-Care management and glycated haemoglobin. Receiver operating characteristics curves were carried out to identify the best cut-off score for each Self-Care scale considering glycated haemoglobin >7% as outcome of interest. Self-Care monitoring and Self-Care management were associated to glycated haemoglobin in both patients without (Self-Care monitoring p = 0.0008; Self-Care management p = 0.0178) and with insulin therapy (Self-Care monitoring p = 0.0007; Self-Care management p = 0.0224). Self-Care maintenance was associated to glycated haemoglobin in patients without insulin therapy (p = 0.0118). Cut-off scores providing the best performance were 70 points for Self-Care maintenance and Self-Care monitoring, and 60 points for Self-Care management. Self-Care maintenance, Self-Care monitoring, and Self-Care management differently affect glycated haemoglobin in patients with type 2 diabetes mellitus. Clinicians could implement tailored interventions to improve glycaemic control considering the lacking area of Self-Care.
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patient and caregiver contributions to self care in multiple chronic conditions a multilevel modelling analysis
International Journal of Nursing Studies, 2020Co-Authors: Davide Ausili, Paolo Iovino, Karen S Lyons, Maddalena De Maria, Ercole Vellone, Christopher S Lee, Barbara Riegel, Maria MatareseAbstract:Abstract Background Multiple chronic conditions (MCC) are highly prevalent worldwide, especially among older populations. Patient Self-Care and care partner (or caregiver) contributions to Self-Care are recommended to reduce the impact of MCC and improve patients’ outcomes. Objectives To describe patient Self-Care and care partner contributions to Self-Care and to identify determinants of patient Self-Care and care partner contributions to Self-Care at the patient and care partner level. Design Multicentre cross-sectional study. Setting Outpatient and community settings in Italy. Participants A sample of 340 patients with MCC and care partner dyads was recruited between 2017 and 2018. Methods We measured patient’s Self-Care and care partner contributions to Self-Care in dyads using the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory. To control for dyadic interdependence, we performed a multilevel modelling analysis. Results Patients’ and care partners’ mean ages were 76.65 (± 7.27) and 54.32 (± 15.25), respectively. Most care partners were female and adult children or grandchildren. The most prevalent chronic conditions in patients were diabetes (74%) and heart failure (34%). Patients and care partners reported higher levels of Self-Care monitoring than Self-Care maintenance and management behaviours. Important patient clinical determinants of Self-Care included cognitive status, number of medications and type of chronic condition. Care partner determinants of Self-Care contributions included age, gender, education, perceived income, care partner burden, caregiving hours per week and the presence of a secondary care partner. Conclusions Our findings support the importance of taking a dyadic approach when focusing on patients with MCC and their care partners. More dyadic longitudinal research is recommended to reveal the modifiable determinants of Self-Care and the complex relationships between patients and care partners in the context of MCC.
Jane Mattson Prince - One of the best experts on this subject based on the ideXlab platform.
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self managed versus agency provided personal assistance care for individuals with high level tetraplegia
Archives of Physical Medicine and Rehabilitation, 1995Co-Authors: Jane Mattson Prince, Scott M Manley, Gale G WhiteneckAbstract:Abstract Objective: To determine whether a finite population, with severe physical disability, had better perceived quality of life, health status, and lower cost depending on whether they used agencies for their caregivers or hired, trained, and reimbursed their caregivers, independently. Design and Setting: A survey, including demographics and portions of the Rand-36, LSI-A, PASI, PIP and CHART. The interviews were completed by telephone, by the leading author. Participants: Seventy-one persons who had sustained spinal cord lesions between C1 and C4. All were at least 1 year postinjury and had received rehabilitation at a local hospital in Englewood, Colorado. Ten additional persons came from the leading author's case management caseload or from a Boston rehabilitation center. They were interviewed in person for pretesting. Main Outcome Measures: Chi square, t tests, and multiple regression analysis, which controlled for potentially confounding group differences. Individuals were placed in two cohorts. Twenty-nine persons received primarily agency provided care and 42 individuals used personal care attendants. Results:> The self-managed group showed significantly better health outcomes, with fewer rehospitalizations and diminished preventable complications. They also experienced greater life satisfaction and significantly lower costs. Those in the self-managed care group had significantly higher composite scores on Rand-36, indicating higher perception of recent health status. Significant differences in mean PIP scores indicated that members of the self-managed care cohort perceived greater control over day-to-day lives. PASI scores showed that persons in this cohort had greater satisfaction with their caregivers and costs. Cost benefit analysis showed appreciable lowering of costs in the self-managed care group. Conclusions: The self-managed care group had many more hours of paid attendant care, whereas the agency provider group had almost equal amounts of care from paid and unpaid providers. Persons using self-managed care reported having fewer medical problems, fewer hospitalizations and better perception of health. Participants declared greater satisfaction in having a choice of caregivers. Persons who were self-managing their care spent less money and used more hours of paid care. The financial burden borne both by the individual and society and the emotional burden borne by families and friends were diminished by the persons managing their care individually.
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self managed versus agency provided personal assistance care for individuals with high level tetraplegia
Archives of Physical Medicine and Rehabilitation, 1995Co-Authors: Jane Mattson Prince, Scott M Manley, Gale G WhiteneckAbstract:Abstract Objective: To determine whether a finite population, with severe physical disability, had better perceived quality of life, health status, and lower cost depending on whether they used agencies for their caregivers or hired, trained, and reimbursed their caregivers, independently. Design and Setting: A survey, including demographics and portions of the Rand-36, LSI-A, PASI, PIP and CHART. The interviews were completed by telephone, by the leading author. Participants: Seventy-one persons who had sustained spinal cord lesions between C1 and C4. All were at least 1 year postinjury and had received rehabilitation at a local hospital in Englewood, Colorado. Ten additional persons came from the leading author's case management caseload or from a Boston rehabilitation center. They were interviewed in person for pretesting. Main Outcome Measures: Chi square, t tests, and multiple regression analysis, which controlled for potentially confounding group differences. Individuals were placed in two cohorts. Twenty-nine persons received primarily agency provided care and 42 individuals used personal care attendants. Results:> The self-managed group showed significantly better health outcomes, with fewer rehospitalizations and diminished preventable complications. They also experienced greater life satisfaction and significantly lower costs. Those in the self-managed care group had significantly higher composite scores on Rand-36, indicating higher perception of recent health status. Significant differences in mean PIP scores indicated that members of the self-managed care cohort perceived greater control over day-to-day lives. PASI scores showed that persons in this cohort had greater satisfaction with their caregivers and costs. Cost benefit analysis showed appreciable lowering of costs in the self-managed care group. Conclusions: The self-managed care group had many more hours of paid attendant care, whereas the agency provider group had almost equal amounts of care from paid and unpaid providers. Persons using self-managed care reported having fewer medical problems, fewer hospitalizations and better perception of health. Participants declared greater satisfaction in having a choice of caregivers. Persons who were self-managing their care spent less money and used more hours of paid care. The financial burden borne both by the individual and society and the emotional burden borne by families and friends were diminished by the persons managing their care individually.
Debra K. Moser - One of the best experts on this subject based on the ideXlab platform.
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Abstract 20468: Self-Care Confidence Moderates the Relationship Between Marginalization and Self-Care Maintenance in Heart Failure Patients
Circulation, 2017Co-Authors: Foster Osei Baah, Debra K. Moser, Marguerite Daus, Kristen A. Sethares, Onome Osokpo, Jennifer C. Miller, Barbara RiegelAbstract:Background: Marginalized individuals in society are less motivated to care for themselves. Adequate Self-Care behavior is known to improve outcomes in patients with heart failure (HF), but the relationship between marginality and Self-Care has not been explored. Prior research suggests Self-Care confidence can influence Self-Care behavior. Methods: We enrolled 287 community-living adults with any type of HF from inpatient settings and outpatient clinics in four northeastern and southern cities in the US and via an online national clinical research registry, ResearchMatch.com. Demographic data were used to calculate marginality scores as the sum of 3 variables: race (white, other, black), education (college, trade school, high school), and income adequacy (more than enough, enough, less than enough) for 9 total points; higher scores indicate higher marginality. All completed the Self-Care of HF Index (SCHFI v7.1). We used Self-Care maintenance (reflects Self-Care behavior) and Self-Care confidence scales in the analysis. All SCHFI scale scores were standardized (0-100). Higher scores indicate better Self-Care and higher Self-Care confidence. Standard mediator and moderator analyses were performed. Results: The sample was mainly white (78%), male (68%), with a mean age 62±13.5. We regressed Self-Care maintenance on marginality. There was a weak negative linear correlation (r = - 0.15, p Conclusion: HF patients in marginalized groups are at risk for poor Self-Care maintenance, but this association is moderated by Self-Care confidence. Interventions that augment Self-Care confidence may be particularly important in marginalized groups.
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living arrangements modify the relationship between depressive symptoms and self care in patients with heart failure
Journal of Cardiovascular Nursing, 2017Co-Authors: Kyoung Suk Lee, Terry A Lennie, Ju Young Yoon, Debra K. MoserAbstract:Background Depressive symptoms hinder heart failure patients' engagement in Self-Care. As social support helps improve Self-Care and decrease depressive symptoms, it is possible that social support buffers the negative impact of depressive symptoms on Self-Care. Objective The purpose of this study is to examine the effect of living arrangements as an indicator of social support on the relationship between depressive symptoms and Self-Care in heart failure patients. Methods Stable heart failure patients (N = 206) completed the Patient Health Questionnaire-9 to measure depressive symptoms. Self-Care (maintenance, management, and confidence) was measured with the Self-Care of Heart Failure Index. Path analyses were used to examine associations among depressive symptoms and the Self-Care constructs by living arrangements. Results Depressive symptoms had a direct effect on Self-Care maintenance and management (standardized β = -0.362 and -0.351, respectively), but not on Self-Care confidence in patients living alone. Depressive symptoms had no direct or indirect effect on any of the 3 Self-Care constructs in patients living with someone. Conclusions Depressive symptoms had negative effects on Self-Care in patients living alone, but were not related to Self-Care in patients living with someone. Our results suggest that negative effects of depressive symptoms on Self-Care are buffered by social support.
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Role of Self-Care in the Patient with Heart Failure
Current cardiology reports, 2012Co-Authors: Debra K. Moser, Christopher S Lee, Victoria Vaughan Dickson, Tiny Jaarsma, Anna Strömberg, Barbara RiegelAbstract:Optimal outcomes and quality of life for patients with heart failure depend on engagement in effective Self-Care activities. Self-Care is a complex set of activities and most clinicians are not adequately prepared to assist their patients to engage in effective Self-Care. In this paper, we provide an overview of Self-Care that includes definitions, the importance of Self-Care to outcomes, the physiologic basis for better outcomes with good Self-Care, cultural perspectives of Self-Care, and recommendations for the improvement of Self-Care. Promotion of effective Self-Care by all clinicians could substantially reduce the economic and personal burden of repeated rehospitalizations among patients with heart failure.
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conceptualizing self care in heart failure a life course model of patient characteristics
Journal of Cardiovascular Nursing, 2008Co-Authors: Debra K. Moser, John F WatkinsAbstract:Self-Care is fundamental to achieving optimal outcomes in patients with heart failure. Unfortunately, Self-Care among patients with heart failure is commonly poor, and patients have considerable difficulties performing Self-Care skills. Elderly patients, in particular, face a number of challenges trying to engage in adequate Self-Care. Heart failure Self-Care is an intricate process that is the result of decisions made on many levels by patients. Little is known about Self-Care decision making in patients with heart failure, and the existing literature does not take into account the complexity of interrelated factors that affect Self-Care decision making. In this article, a model of factors affecting Self-Care decision making that include aging status, psychosocial status, health literacy, current symptom status, and prior experiences is proposed.
