Influences of Race and Sex on Self-Care for Persons with Heart Failure and Diabetes

Abstract

Introduction Persons with both diabetes (DM) and heart failure (HF) have complex self-care. Self-efficacy and knowledge influence a patient's ability to manage these chronic conditions. In other populations, differences between race and gender have been reported in areas of disease specific knowledge, self-efficacy, and self-care. Greater understanding of differences by race and gender is significant for improving HF-DM self-care and quality of life (QOL). The purpose of this study was to examine HF-DM knowledge, self-care, efficacy, and QOL in racial groups (White, Black) and by sex (men/women) in order to inform culturally congruent care. Hypothesis There are differences in self-care and antecedents of self-efficacy, knowledge, and outcomes of QOL by race and sex. Methods In a secondary analysis, baseline data were examined from 134 persons with HF-DM participating in a trial to improve co-morbid self-care. Participants were 69% Black, and 66% men. Mean age was 57.4 ± 10.6 years. Variables and measures included demographics, clinical factors (HF severity, years with HF, and DM), HF knowledge (AHFKQ), social support (ESSI), self-care efficacy and behavior (SCHFI); HF and DM QOL (MLWHF, ADDQOL), and health status (EQVAS). DM variables were self-care (SCSDA), knowledge (MDKT), and self-efficacy (PDSMS). Group comparison tests were performed using chi squares, t-tests, and non-parametric Mann Whitney tests. Results Black participants had higher body mass index (BMI) (p=.04), higher PDSMS (p=.009) and SCSDA foot care scores (p=.04), and lower MDKT (p=.001), ESSI (p=.05), and ADDQOL scores (p=.03) than white participants. Men were diagnosed with HF longer than DM (p=.02), had higher EQVAS (p=.006) and lower SCHFI confidence (p=.05) and foot care scores (p=.005). Women had lower severity of HF (p=.006) and had lived with HF longer than men (p=.02). Conclusions Results revealed differences in self-care, self-care antecedents, and QOL by race and sex. Implications include HF-DM education and social support interventions to improve overall QOL and self-care in Blacks. More focus on DM self-efficacy and foot care is warranted for men, as well as greater attention to longer term HF symptoms and QOL for women. Culturally relevant care and sex-based interventions are needed to address self-care needs for those with co-morbid conditions.