Abstract 18299: Perceived Social Support Operates Through Self-Efficacy to Positively Influence Heart Failure Self-Care Management

Abstract

Background: Studies show a modest positive association between social support and chronic illness self-management. However, the extent to which social support influences Heart Failure (HF) self-care and whether HF self-efficacy mediates this relationship is not well understood. Methods: We conducted a cross-sectional survey of community-dwelling patients with systolic or diastolic HF seen in a university internal medicine or cardiology clinic. We separately assessed HF self-care maintenance (i.e. engaging in behaviors to help maintain physiologic stability- medication adherence and frequent weighing) and self-care management (i.e. decision-making in response to symptoms- recognizing signs of fluid overload and adjusting diuretic dose) using the Self-Care of Heart Failure Index (SCHFI). Emotional/informational support was assessed using the Medical Outcomes Study social support survey. HF self-efficacy was assessed using the SCHFI self-efficacy subscale. We used linear regression to examine differences in self-management behaviors, adjusting for age, race, gender, marital status, education, income, and self-rated health. Mediation analysis was done according to Baron & Kenny method. Results: Of the 146 participants (mean age 61yrs; 51% female; 43% African Americans), mean (SD) emotional/information support and self-efficacy were 82.4 (SD 19.8) and 64.5 (SD 17.0), respectively; 33% had “adequate” HF self-efficacy (scores ≥ 70). In multivariable analysis, more emotional/informational support was associated with better self-care maintenance (B coefficient 0.14, SE 0.60; p=0.03). More emotional/information support was associated with better self-care management (B coefficient 0.23, SE 0.11; p=0.04) in bivariate but not multivariable analysis (B coefficient 0.18, SE 0.12; p=0.12). HF self-efficacy strongly mediates the association between emotional/informational support and self-care maintenanc e, but not management. Conclusion: Emotional/informational support is more strongly associated with behaviors to maintain physiologic stability than with decision-making related to symptom management. Greater self-efficacy is a mechanism by which emotional/informational support influences HF self-care management .