Self-care Maintenance Research Articles

Effects of a transition care program on depression, self-efficacy, and self-care behaviors in heart failure patients

IntroductionHeart failure is a progressive and unpredictable heart disease. How to work with these patients to decrease their psychological distress and promote their self-care behaviors is important. Transition care is the continuity of medical care for heart failure patients returning home from the hospital. Intervention through transition care may improve the continuity of medical care for patients with heart failure but it has not been examined in clinical settings in Taiwan.ObjectivesThe aims of this study were to explore the effects of a newly developed transition care program on depression, self-efficacy, and self-care behavior of heart failure patients.Methods Using an experimental research design and block randomization, participants were divided into the experimental group (received transition care and routine care) and the control group (received routine care only). The Patient Health Questionnaire-9 (PHQ-9), the General Self-Efficacy Scale (GSES), and the Self-Care of Heart Failure Index (SCHFI version 6.2) were used to collect data before discharge and the first month after discharge.Results A total of 20 patients with heart failure were recruited. No significant differences were found between the experimental (n=10) and control groups (n=10) in the degree of depression (Z=-.077, p=.938), self-efficacy (Z=-1.214, p=.225), and three self-care behaviors subscales (self-care maintenance Z= -1.214, p=.225; self-care management Z= -.401, p=.689; self-care confidence Z=-.436, p=.663) at discharge. After the one-month posttest, only self-efficacy (Z=-2.545, p=.011) and three self-care behaviors subscales (self-care maintenance Z=-3.097, p=.002; self-care management Z= -2.595, p=.009; self-care confidence Z=-3.671, p<.001) reached a statistical difference between the two groups.ConclusionsBased on the preliminary results, heart failure patients can improve their self-care behavior and self-efficacy but not depression through transitional care intervention.Disclosure of InterestNone Declared

Self-care of chronic illness prevents the risk of diabetic foot ulcers in patients with diabetes: a cross-sectional study

Introduction: Diabetic foot ulcer (DFU) is a serious and chronic complication of diabetes mellitus (DM). This study aims to explain a model of self-care of chronic illness on the prevention of DFU risk in patients with DM, including foot self-care of maintenance, monitoring, and management. Methods: This study was an analytical study with a cross-sectional approach, with 300 patients randomly selected from six Public Health Centers in Surabaya, Indonesia, from June to August 2022. The inclusion criteria were individuals with DM and aged more than 26 years. Exclusion criteria were reading disabilities or having cognitive impairments Data were collected using a questionnaire. The correlation between variables was analyzed using the statistical method of Partial Least Squares. Results: The risk of DFU in patients with DM was 40% with low risk, 38% with moderate risk, 8% with high risk, 5% remission, and 10% with DFU. This research shows that there is a significant correlation between foot self-care management and the risk of DFU, where the p-value = 0.000, while the indicators of foot self-care maintenance and self-care monitoring do not have a significant correlation with the risk of DFU, where the p-value is respectively equal to 0.350 and 0.844. Conclusions: Foot self-care management was a factor that directly correlates with the risk of DFU. Autonomous self-care management behaviors still needed to be improved, because most patients still had these inadequate behaviors. Further research is needed to improve the behavior quality of patients with DM in managing foot care independently.

The Effect of Distance Education on Self-care in Patients With Heart Failure in the Chronic or Stable Phase: A Systematic Review and Meta-analysis.

Health education is important for self-care in patients with heart failure. However, the evidence for the effect of distance education as an intervention to deliver instruction for patients after discharge through digital devices on self-care is limited. In this study, our aim was to explore the effect of distance education on self-care in patients with heart failure. We searched 11 electronic databases and 3 trial registries for randomized controlled trials with low risk of bias and high-quality evidence to compare the effect of usual and distance education on self-care. Quality appraisal was performed using the Cochrane Risk of Bias Tool. Using the Review Manager 5.4 tool, a meta-analysis was conducted. Certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Fifteen articles were eligible for this study. Compared with usual education, distance education improved self-care maintenance (mean difference [MD], 6.62; 95% confidence interval [CI], 3.93-9.31; GRADE, moderate quality), self-care management (MD, 5.10; 95% CI, 3.25-6.95; GRADE, high quality), self-care confidence (MD, 6.66; 95% CI, 4.82-8.49; GRADE, high quality), heart failure knowledge (MD, 0.78; 95% CI, 0.01-1.56; GRADE, moderate quality), and quality of life (MD, -5.35; 95% CI, -8.73 to -1.97; GRADE, moderate quality). Subgroup analysis revealed distance education was more effective than usual education in self-care when the intervention was conducted for 1 to 6 months, more than 3 times per month, and a single intervention lasting more than 30 minutes. This review shows the benefits of distance education on self-care, heart failure knowledge, and quality of life of patients with heart failure. The intervention duration, frequency, and duration of a single intervention could have affected the intervention effect.

Caregivers' Contributions to Heart Failure Self-care: An Updated Systematic Review.

A previous systematic review reporting the contributions of informal, unpaid caregivers to patient heart failure (HF) self-care requires updating to better inform research, practice, and policy. The aim of this study was to provide an updated review answering the questions: (1) What specific activities do informal caregivers of adults with HF take part in related to HF self-care? (2) Have the activities that informal caregivers of adults with HF take part in related to HF self-care changed over time? (3) What are the gaps in the science? This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, EMBASE, and Cochrane CENTRAL databases were searched. Eligible studies involved an informal, unpaid caregiver of an adult with HF as a study variable or participant. Caregiving activities were benchmarked using the theory of self-care in chronic illness. Two thousand one hundred fifty-four research reports were identified, of which 64 met criteria. Caregivers' contributions occurred in self-care maintenance (91%), monitoring (54%), and management (46%). Activities performed directly on or to the patient were reported more frequently than activities performed for the patient. Change over time involved the 3 domains differentially. Gaps include ambiguous self-care activity descriptions, inadequate caregiving time quantification, and underrepresented self-care monitoring, supportive, and communication activities. Newly identified caregiver-reported activities support updating the theory of self-care in chronic illness to include activities currently considered ancillary to HF self-care. Identified gaps highlight the need to define specific caregiving activities, determine task difficulty and burden, and identify caregiver self-care strategy and education needs. Exposing the hidden work of caregiving is essential to inform policy and practice.

Description of self-care behaviours in patients with non-valvular atrial fibrillation on oral anticoagulant therapy: a scoping review.

The primary aim of this scoping review was to explore and categorize the medication-related self-care behaviours exhibited by patients with non-valvular atrial fibrillation (NVAF) who are on oral anticoagulant (OAC) therapy. A scoping review was performed, and the systematic search of the literature yielded an initial 887 records. After deduplication and screening, 61 studies were included in the analysis, ranging from 2003 to 2023. The studies represented a wide geographical distribution and diverse methodologies. The results identified 16 self-care behaviours: a higher focus of the included literature on self-care monitoring (60.65% of studies), followed by self-care management and self-care maintenance (each 16.39%). These behaviours ranged from regular blood testing to consulting healthcare providers and lifestyle changes. The results also highlighted the relationship between treatment satisfaction, self-efficacy, and adherence. Several studies emphasized the critical role of healthcare providers in influencing medication adherence. Furthermore, patient knowledge, quality of life, and psychological factors were identified as key elements affecting self-care behaviours. The review provides a comprehensive landscape of medication-related self-care behaviours among NVAF patients on OAC therapy. It underscores the predominance of self-care monitoring behaviours and the critical roles of healthcare providers, psychological factors, and patient knowledge in influencing these behaviours. The findings also highlight the necessity for an integrated, patient-centred approach to improving self-care and self-management in OAC treatment. Future research should focus on addressing the identified gaps, including the relative lack of studies on lifestyle modification, emotional well-being, and technology-assisted interventions. This review is part of a broader project and is documented at ClinicalTrials.gov: NCT05820854.

N06 Self-care in patients affected by inflammatory bowel disease: SELF-IBD observational study in a single center

Abstract Background Self-care is an active process to maintain and promote health in chronic disease situations, and is effective in the results of many chronic diseases. So far, few studies have been conducted on the self-care of IBD. The study of self-care in IBD is also motivate, by the increase in prevalence in the coming years and the impact on health resources it could have. In addition, the study of self-care in relation to socio-sanitary features and habits within the population affected by IBD may be the beginning to identify areas for educational interventions by health care personnel. The primary objective of this study is to describe the levels of self-care maintenance, monitoring and management in patients with IBD. Methods Cross-sectional observational study to evaluate self-care in IBD patient. The questionnaire used was the Self-Care of Chronic Disease Index (SCCII). The SCCII investigates three aspects of self-care, maintenance, monitoring and management and the self-efficacy. The sociodemographic characteristics and some patient habits such as smoking habit, fatigue, exercise, sleep, nutrition and supplement use, were investigated. Ethics Committee approved Results We enrolled 85 patients with an average age of 44.8±16.8, of which 51.8% (female) and 50.6% (CD), 48.4% (UC). The level of self-care (SCCII) areas investigated ranged from score levels of 71.30 (Self-maintenance), 79.52 (self-monitoring), 68.94 (self-management) and 75.70 (self-efficacy). In the area of self-care maintenance the aspects that seem least considered by patients (never or rarely) are stress management (44.1%) and exercise (40%). Only 57.6% of patients often or always get enough sleep and only 22.3% of patients follow a healthy diet. The presence of fatigue seems to affect 68% of patients in the self-monitoring phase. In the area of self-management, only 41.2% of patients (often or always) try to rest during the day and only 52% of the sample succeeds continuously with the appearance of symptoms. In self-efficacy, it seems that 85.8% of the patients interviewed persist in following the treatment even when it is difficult. It seems that men have more significant levels of self-maintenance score 74. vs 68.8 (p>0.01) than women. Table 1 shows the average self-care scores in relation to the habits investigated. Conclusion From the results of our study it seems that patients with IBD have adequate levels of self-care (score ≥70), although sleep/rest, diet and exercise seem not to be highly considered by patients. Future studies may investigate which specific sociodemographic and clinical characteristics can be identified as predictors of maintaining self-care, self-care management and self-confidence, to improve areas of nurse educational intervention.

The Effect of Community-Based Intervention on Dengue Awareness and Prevention Among Poor Urban Communities in Delhi, India.

This study aimed to assess the efficacy of a dengue intervention program in economically deprived urban regions of India, with a particular emphasis on housing conditions and community involvement. Given the global significance of dengue fever as a vector-borne disease, successful vector management requires effective community engagement. Study Design: A quasi-experimental study. This study was conducted with 314 participants from Delhi's Sanjay Colony, divided into control and intervention groups. The study spanned 14 months (August 2020 to September 2021). The intervention program comprised two educational sessions held one month apart, covering dengue awareness, health self-care, and environmental maintenance. Data were collected at baseline, after each intervention session, and during a final follow-up assessment three months later. The primary outcome, the house index (HI), revealed statistically significant differences (P<0.001) favoring the intervention group. The total score (TS) for mosquito-borne disease, TS of knowledge, TS of attitude, and TS of practices all exhibited significant improvements in the intervention group. Participants showed an enhanced understanding of dengue causes, symptoms, and mosquito behavior related to breeding and biting. The HI in the intervention group decreased significantly from 21.65% to 4.45% (P<0.05). This study, grounded in the health belief model (HBM), demonstrated the effectiveness of the intervention program in reducing HI and improving knowledge and preventive practices regarding dengue fever in impoverished urban neighborhoods of Delhi. The intervention program may be beneficial in such a poor urban community.

Patient-reported measures for integrated care assessment: interprofessional collaboration, self-care and outcomes.

Chronicity is spreading and rapidly becoming a urgent issue also for the complexity of care. 32.2 million of NCD deaths (80%) are due to chronic diseases (1). Every country has been developing strategies to guarantee assistance to chronic patients while ensuring the sustainability of the system. Interprofessional collaboration is among the features to improve the assistance for chronic patients and to reach coordination, appropriateness, and continuity along the care pathways (2,3). Data collection on this topic is still scarce, especially from the point of view of patients themselves. Patient Reported Outcome and Experience Measures (PROMs and PREMs) collected in an integrated way can help in understanding the relationship of experience and outcome along the patient care pathway, thus providing a complete vision of the quality and integration of care from the patient perspective (4).&#x0D; This work aims at reporting some preliminary results about the impact of interprofessional collaboration on the health outcomes and self-care capacity of chronic heart failure (CHF) patients. &#x0D; Data from the Observatory on PROMs and PREMs of the Tuscany Region in Italy will be used to explore the hypothesis that interprofessional collaboration can lead to better self-care and outcome scores as reported by patients. The selected sample replied to four questionnaires: one at discharge by the hospital, a first follow-up after 30 days; a second follow-up after 7 months; a final follow-up after 12 months (5). Average scores and deltas for the KCCQ-12 and the SCHFI scales will be used to detect potential differences between patients’ self-care, health status and quality of care according to the reported level of integration between the general practitioner and the specialist.&#x0D; 132 responses were valid to be analysed. At baseline, 23% of patients declared that their GP and their specialist were in contact to take care of the care pathway, 15% declared they did not know. Differences between scores are not significant for the KCCQ-12 on health status and quality of life. A weak difference emerged for the Self-care Maintenance about daily lifestyle adherence. &#x0D; Further research should be conducted on this topic to understand if these results are linked to a scarce knowledge of patients with respect to the joint work of GPs and specialists or if the interprofessional collaboration is not sufficient to guarantee an improvement of outcomes, at least for CHF patients. Indeed, the same analyses could be repeated on other two chronic populations (e.g. diabetic and IBD patients) which are providing their data that will be available next year.&#x0D; &#x0D; 1.2018. “NCD Countdown 2030: Worldwide Trends in NCD Mortality and Progress towards Sustainable Development Goal Target 3.4.” Lancet &#x0D; 2.Pascucci2021. “Impact of Interprofessional Collaboration on Chronic Disease Management.” Health Policy &#x0D; 3.Davidson2022. “What Do Patients Experience? Interprofessional Collaborative Practice for Chronic Conditions in Primary Care” BMC Primary Care&#x0D; 4.Pennucci“Can the Jointly Collection of PROMs and PREMs Improve Integrated Care?” IJIC&#x0D; 5.Pennucci“Piloting a Web-Based Systematic Collection and Reporting of PROMs/PREMs in Chronic Heart Failure.” BMJ Open&#x0D;

Psychometric properties of the Chinese version of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory based on the Middle-Range Theory of Self-Care of Chronic Illness.

To test the psychometric properties of the Chinese version of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory on a sample of patients with chronic obstructive pulmonary disease in China. Measuring the self-care of patients with chronic obstructive pulmonary disease is vital to promote the performance of effective self-care behaviours. However, few instruments have been developed to measure self-care in chronic obstructive pulmonary disease, and the existing instruments lack theoretical support and satisfactory psychometrics properties. The Self-Care in Chronic Obstructive Pulmonary Disease Inventory based on Middle-Range Theory of Self-Care of Chronic Illness has been developed and tested previously in Italian and US population. A cross-sectional instrument development study. Construct validity was tested by confirmatory factor analysis and hypothesis testing, and reliability internal consistency using factor score determinacy coefficients. A convenience sample of 185 patients with chronic obstructive pulmonary disease was recruited from September 2020 to January 2022. The instrument consists of three scales: self-care maintenance, self-care monitoring and self-care management. Confirmatory factor analysis performed on the three scales produced good fit indices. The internal consistency was adequate with factor score determinacy coefficients ranging from 0.891 to 0.953 in Self-Care Maintenance Scale, 0.990 to 0.993 in Self-Care Monitoring Scale and 0.750 to 0.976 in Self-Care Management Scale. The Chinese version of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory has acceptable reliability and validity. Some differences from the original instrument were identified. Further validation studies should be conducted to confirm the psychometric properties of the instrument in Chinese population.

Mediators of the Association Between Cognitive Function and Self-care Behaviors in Patients Hospitalized With an Exacerbation of Heart Failure.

Patients with heart failure (HF) must engage in self-care, yet their self-care is often poor. Cognitive function commonly is impaired in HF and is associated with poor self-care. Heart failure knowledge and self-care confidence also are needed to preform self-care. Few investigators have examined mediators of the association of cognitive function with self-care. The aim of this study was to determine whether HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance and management among patients with HF. This was a cross-sectional observational study of 164 patients with HF. Cognitive function was assessed using the Montreal Cognitive Assessment. Self-care maintenance and self-care management behaviors and self-care confidence were measured using the Self-care of Heart Failure Index. Heart failure knowledge was measured using the Dutch Heart Failure Knowledge Scale. We conducted 2 parallel mediation analyses using the PROCESS macro in SPSS, one for self-care maintenance and one for self-care management. Cognitive function was indirectly associated with self-care maintenance through HF knowledge (indirect effect, 0.54; 95% confidence interval, 0.10-1.02) and self-care confidence (indirect effect, 0.26; 95% confidence interval, 0.04-0.54). Those with better cognitive function had more HF knowledge and self-care confidence. Better cognitive function was not directly associated with self-care management but indirectly associated with better self-care management through higher self-care confidence (indirect effect, 0.50; 95% confidence interval, 0.04-1.05). Both HF knowledge and self-care confidence mediated the association of cognitive function with self-care maintenance, and only self-care confidence mediated the association between cognitive function and self-care management. Interventions targeting HF knowledge and self-care confidence may improve self-care even for those with lower cognitive function and need to be developed and tested.

Self-care nursing assessment: cross-cultural adaptation and validation of the Spanish version of the Self-care of chronic illness inventory

BackgroundSelf‐care is the primary means of caring for a chronic condition. Therefore, it is necessary to assess it by using a good validity and reliability instrument. The Self-Care of Chronic Illness Inventory (SC-CII) is a generic instrument developed to measure self-care processes behaviors using three separate scales in patients with chronic illness. The original cross-cultural assessment concluded the need for future studies sampling patients from different sites to increase the generalizability of the psychometric evaluation results. It was unclear whether this tool had sound psychometrics properties in the context of Spanish culture. The purpose of this study was to cross-culturally adapt the SC-CII, test its psychometric properties and validate its use among Spanish people with chronic diseases.MethodsA cross-cultural translation of the SC-CII was performed from English to Spanish. The psychometric evaluation was conducted in a sample of 350 patients with chronic conditions through a multicenter cross-sectional study based on the STROBE guideline. Data were collected from face-to-face interviews during 2022. Internal validity was assessed with Confirmatory Factor Analysis, internal consistency reliability with Cronbach alpha for unidimensional scales and McDonald's Omega reliability coefficient for multidimensional scales.ResultsMost (63.4%) participants were older adults aged 65 years or older with a mean age of 65.45 ± 14.97. The average number of chronic conditions reported was 2.81%; the most common conditions were hypertension (52.3%), musculoskeletal disorders (46.3%) and diabetes (38.9%). Patients reported adequate self-care behaviors in all three scales of the SC-CII. The Self-Care Maintenance and Management scales were multidimensional, and the Self-Care Monitoring scale was unidimensional. In Confirmatory Factor Analysis, the Self-Care Maintenance and Monitoring scales had satisfactory fit indices. The Self-care Management scale had acceptable fit indices. The Omega reliability coefficient for multidimensional scales was 0.75 (Self-Care Maintenance) and 0.72 (Self-Care Management). The Cronbach alpha coefficient of the Self-Care Monitoring scale was 0.85. Item-total correlations were all significant except one. Test–retest reliability showed an intraclass correlation coefficient of 0.92.ConclusionsThe SC-CII has appropriate psychometrics characteristics and is a culturally suitable and reliable instrument for assessing to the self-care behaviors of patients with chronic disease in Spain. The scale provides a simple and rapid solution to assess the self-care process.

Urban-rural differences in associations among perceived stress, resilience and self-care in Chinese older adults with multiple chronic conditions.

Social determinants of health (SDH) are mainly comprised of structural and intermediary domains. Emerging evidence suggests that the burden of multiple chronic conditions (MCCs) in older adults is exacerbated by structural determinants (e.g. low income and low education). However, less attention was paid to the intermediary determinants (i.e. material circumstances, psychosocial factors and behavioural factors) of MCCs. To investigate the associations among perceived stress, resilience and self-care in Chinese older adults with MCCs by comparing urban and rural groups. A convenience sample (125 and 115 participants from urban and rural settings, respectively) of Chinese older adults with MCCs was enrolled between January and April 2022. Hierarchical multiple regression analyses and propensity score weights were used to determine the associations among perceived stress, resilience and self-care. Hypothesis 1 regarding the negative associations between perceived stress and self-care was fully supported in the rural group. However, for the urban group, the negative association was only supported for the relationship between MCCs-related perceived stress and self-care maintenance. Hypothesis 2 was fully supported regarding the positive associations between resilience and the three components of self-care in both groups, although the relationship between resilience and self-care monitoring was marginally significant in the urban group. Hypothesis 3 regarding the moderating effect of resilience was only supported in the relationship between general perceived stress and self-care monitoring in the rural group. After adding the propensity score weights, the moderating effect was no longer statistically significant in the rural group. The urban-rural disparities in the Chinese context might largely be attributed to the complex interactions of the structural determinants and intermediary determinants. Findings can inform the development of culturally tailored interventions to promote self-care and reduce urban-rural disparities for Chinese older adults with MCCs. With the increasing number of older adults in China who are living with multiple chronic conditions and the call for effective interventions to improve their health outcomes, current findings can inform the development and implementation of nurse-led culturally tailored interventions to promote self-care and reduce urban-rural disparities for Chinese older adults with MCCs.

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure: A Qualitative Study.

Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.

Longitudinal Relationships Between Heart Failure Self-care and All-Cause Hospital Readmissions.

Many patients with heart failure (HF) are repeatedly hospitalized. Heart failure self-care may reduce readmission rates. Hospitalizations may also affect self-care. The purpose of this secondary analysis was to test the hypotheses that better HF self-care is associated with a lower rate of all-cause readmissions and that readmissions motivate patients to improve their self-care. This was a prospective cohort study of patients with HF (N = 400) who were enrolled during a stay at an urban teaching hospital between 2014 and 2016. The Self-Care of Heart Failure Index v6.2 was administered during the hospital stay, along with other questionnaires, and repeated at 6-month intervals after discharge. All-cause readmissions and deaths were ascertained for 24 months. A total of 333 (83.3%) were readmitted at least once, and 117 (29.3%) of the patients died during the follow-up period. A total of 1581 readmissions were ascertained. Higher Self-Care of Heart Failure Index Maintenance scores predicted more rather than fewer readmissions (adjusted hazard ratio, 1.09; 95% confidence interval, 1.01-1.17; P < .01). Conversely, more readmissions predicted higher Maintenance scores (b = 0.29; 95% confidence interval, 0.02-0.56; P < .05). These findings do not support the hypothesis that HF self-care maintenance or management helps to reduce the rate of all-cause readmissions, but they do suggest that the experience of multiple readmissions may help to motivate improvements in HF self-care.

Abstract 12756: The Interplay of Self-Care Maintenance, Social Support, Depressive Symptoms and Anxiety in Predicting Quality of Life in Patients With Heart Failure

Introduction: Depressive symptoms, anxiety, and inadequate social support are predictors of quality of life (QOL) in patients with heart failure (HF), but prediction of QOL is multifaceted and mechanisms underlying association are unknown. Essential to better HF outcomes, self-care maintenance (SCM) may moderate associations among these predictors. The interplay among depressive symptoms, anxiety, social support, and SCM and their influence on QOL remains uncertain. Purpose: To determine whether (1) depressive symptoms and anxiety mediate the association of social support with QOL, and (2) SCM moderates the relationship of social support with depressive symptoms, anxiety, and QOL. Methods: We included 167 patients (61 ± 12 years old, 65% male, 47% NYHA III/IV) with HF, who completed the Patient Health Questionnaire-9 to measure depressive symptoms, Brief Symptom Inventory for anxiety, Multidimensional Scale of Perceived Social Support for social support, Self-Care of Heart Failure Index for SCM, and Minnesota Living with Heart Failure Questionnaire for QOL. A moderated mediation model was performed using PROCESS macro. Results: We found an indirect association of social support with QOL, mediated by depressive symptoms and anxiety (Figure). The beneficial impact of social support on depressive symptoms and anxiety varied with SCM, suggesting a dose-response moderation effect, which is attenuated at lower SCM scores (Figure). The indices of moderated mediation via depressive symptoms and anxiety were -.007 (95%CI: -.150, -.002) and -.005 (95%CI: -.010, -.002), respectively. There was no direct nor moderated direct effect. Conclusions: There is a pivotal interplay of SCM, depressive symptoms, anxiety, social support, and QOL in HF. Findings suggest that improvement in depressive symptoms and anxiety may improve QOL in HF. Moreover, good SCM may enhance the positive effect of social support on depressive symptoms and anxiety.

Abstract 14432: Self-Care Clustering in Adults With Type 1 Diabetes

Poor glycemic control in type 1 diabetes (T1D) may result in cardiovascular disease. Self-care, or the process of maintaining health through health-promoting behaviors and managing illnesses when changes are detected, may improve glycemic control and outcomes. However, self-care in T1D is ill-defined. We examined how self-care maintenance, monitoring, and management cluster in adults with T1D and identified unique characteristics of individuals within each cluster. Adults ( n =200, 27% Black, 61% female) with T1D (median[IQR] age: 35 [22] years, T1D duration: 19 [19] years, insulin pump use: 68%) reported personal, clinical and social determinants of health (SDH; modified PRAPARE tool, scored 0-22; higher is worse) and the Self-Care of Diabetes Inventory (3 self-care scales: maintenance, monitoring, management; 1 confidence scale; scored 0-100; scores ≥ 70 are adequate). Cluster analysis was performed with self-care domains as criteria via Ward’s method. To compare clusters, Kruskal-Wallis and chi-square tests were used for continuous and categorical variables, respectively. Three self-care clusters were found and labeled: Mastery (n= 70, 70% White, insulin pump use: 63%, median [IQR] age: 41 [28] years, T1D: 22 [22] years, Self-Care Maintenance: 85.4 [10.4], Monitoring: 82.4 [8.8], Management: 72.2 [13.9], Confidence: 95.5 [11.4], SDH: 2 [2]); Inconsistent (n= 112, 75% White, Insulin Pump use: 75%, median[IQR] age: 34 [22] years, T1D: 19 [18] years, Self-Care Maintenance: 79.2 [12.5], Monitoring: 67.7 [11.8], Management: 58.3 [13.9], Confidence: 88.6 [15.9], SDH: 3 [2]); and Novice (n= 18, 39% White, Insulin pump use: 44%, median[IQR] age: 25 [9] years, T1D: 14 [10] years, Self-Care Maintenance: 53.1 [9.9], Monitoring: 52.9 [13.2], Management: 44.4 [9.7], Confidence: 64.8 [27.8], SDH: 6 [7]). Significant differences were found for age (p&lt;.001), race (p&lt;.01), insulin pump use (p&lt;.05), Self-Care Maintenance (p&lt;.001), Self-Care Monitoring (p&lt;.001), Self-Care Management (p&lt;.001), Self-Care Confidence (p&lt;.001), and SDH (p&lt;.01). No differences were found in T1D duration. Three distinct profiles of self-care were found in this sample of adults with T1D. Older patients using insulin pumps with fewer SDH risk were more likely to master self-care.

Abstract 17733: Self-Care Maintenance Moderated the Associations Among Symptom Burden, Functional Status, and Quality of Life in Patients With Heart Failure: A Moderated Mediation Analysis

Background: Patients with heart failure (HF) commonly are symptomatic, which causes a decrease in functional status and results in worse health-related quality of life (HRQoL). Self-care maintenance (SCM) is known to prevent escalation of HF symptoms and improve functional status. However, few studies have tested the mechanisms underlying these relationships. Purpose: To determine whether the effect of symptom burden on HRQoL via functional status differs by the high and low SCM groups. Methods: In this cross-sectional study, 114 patients (mean age 63±12 years, 61% male, 70% white, 64% NYHA class III/IV) with HF completed questionnaires on SCM, symptom burden, functional status, and HRQoL measured by the maintenance subscale of the Self-Care of Heart Failure Index, the Memorial Symptoms Assessment Scale-HF, the Duke Activity Status Index, and the Minnesota Living with HF Questionnaire, respectively. Patients were categorized into high and low SCM groups using the standard cut point score of 70. Moderated mediation analysis was conducted using the PROCESS Macro. Results: Self-care maintenance significantly moderated the association of symptom burden with functional status, in that the association of symptom burden with functional status was stronger for the high SCM group (effect = -.083, 95% CI [-.115, -.050] than the low SCM group (effect = -.044, 95% CI [-.063, -.025], (moderation effect F = 4.10, p = .045). Symptom burden was significantly associated with HRQoL directly (effect = .176, 95% CI [.139, .213]) and indirectly through functional status for both high and low SCM groups (moderated mediation effect = .022, 95% CI [.002, .048]), and the indirect effect was two times higher for the high SCM group (effect = .046, 95% CI [.016, .080] than the low SCM group (effect = .025, 95% CI [.010, .042]). Conclusion: Symptom management aimed at improving symptom burden should focus on promoting SCM, which increases functional status, thereby improving HRQoL in patients with HF.

Abstract 15239: Patient Self-Care Mediates the Relationship Between Caregiver Contributions and Symptom Burden in Heart Failure

Introduction: Patients with heart failure (HF) experience high symptom burden that can be mitigated with adequate self-care. The situation-specific theory of caregiver contribution to HF self-care suggests that caregivers have a key role in improving patient symptom burden. Hypothesis: a) caregiver contribution to self-care influences patient self-care; b) patient self-care influences symptom burden; c) patient self-care mediates the relationship between caregiver contribution to self-care and symptom burden. Methods: Secondary analysis of baseline and three-months data from the MOTIVATE-HF trial, which enrolled 510 HF patient-caregiver dyads in Italy. Data were collected using the Self-Care of HF Index v.6.2, the Caregiver Contribution to Self-Care of HF Index, and the HF Somatic Perception Scale. Autoregressive longitudinal path analysis with contemporaneous mediation was used to test study hypotheses. Results: On average, caregivers were 54 ± 15.46 years and mainly female (74.5%), while patients were 72.4 ± 12.28 years and mainly male (68%). Better caregiver contribution to self-care maintenance was associated with better patient self-care maintenance (β=0.280, p&lt;0.001), which, in turn, was associated with lower symptom burden (β=-0.280, p&lt;0.001). Patient self-care maintenance mediated the effect of caregiver contribution to self-care maintenance on symptom burden (β=-0.079, 95% BC bootstrapped CI: -0.130, -0.043). Better caregiver contribution to self-care management was associated with better patient self-care management (β=0.238, p=0.006). The model accounted for 37% of the variance in symptom burden (p&lt;0.001). Conclusions: Targeting caregivers to increase their contribution to self-care can increase patient self-care and, consequently, lower patients’ HF symptom burden.

Abstract 16949: The Effects of the Technology-Based Family-Centered Empowerment (T-FamE) Heart Failure Transitional Program: Preliminary Analysis of a Randomized Controlled Trial

Introduction: Health digitization and advanced dyadic science offer new opportunities to enhance the transitional care model for heart failure (HF). The T-FamE program a transitional care model integrating digital health and optimized carer support to enhance the post-discharge outcomes of HF patients. Hypothesis: The T-FamE was more effective than usual care to enhance self-care, perceived control, family function, HRQoL and hospital readmission of HF patients. Methods: From Aug 2021 to March 2022, a RCT randomized 170 post-discharge HF patients (mean age = 69.0; SD=11.5; NYHA Grade II/III/IV = 53.9/40.6/.5.5%. LVEF&lt;40% =58.5%) to the T-FamE or usual care. The 12-week nurse-delivered T-FamE comprises an interactive mobile Apps, which allows i) proactive health monitoring with tailored autonomous guideline-based feedback; ii) family-centerd goal-setting on self-care, iii) personalized drug education, iv) mobile access to nurse, v) video-based HF compass for rehabilitation and self-care. The cardiac nurse conducted three monthly visits for family-based empowerment on disease management. Outcome evaluation by Self-care Heart Failure index, Self-care Self-Efficacy Scale, Control Attitude Scale, Family Functioning Device and EuroQoL at baseline and post-test. Results: Two-way analysis of covariance showed significant greater improvement of T-FamE group on self-care maintenance (F=21.46, p&lt;0.001, η 2 p =0.113), management (F=22.52, p=0.01, η 2 p =0.118), symptom perception (F=69.70, p&lt;0.001, η 2 p =0.29) and confidence (F=13.36, p&lt;0.001, η 2 p =0.073) than the control. They have greater improvement in EuroQoL (F=5.78, p=0.017, η 2 p =0.033) and sense of control (F=5.78, p=0.017, η 2 p =0.033), and significantly lower number ore readmission in one year (-0.278 (95%CI=-0.54, -0.008, p=0.043). Conclusions: The T-FamE is effective to improve the self-care, HRQL and readmission outcomes. Digitalized transitional care model with optimized family support play explain the therapeutic benefits. Autonomous response to health monitoring data may enhance self-care decision-making.

Abstract 13139: Preliminary Efficacy of a Cognitive Restorative Nature Intervention to Improve Attention, Self-Care, and Health-Related Quality of Life in Heart Failure

Background: Cognitive dysfunction is prevalent among patients with heart failure (HF) and decreases self-care behaviors and health-related quality of life (HRQL). Goal: The purpose was to test preliminary efficacy of a newly developed virtual reality-based cognitive restorative nature intervention (Nature-VR based on Attention Restoration Theory) on improving attention, HF self-care, and HRQL. Methods: In this 2-group randomized controlled trial, 73 patients with Stage C HF were enrolled. The Nature-VR intervention group (n=37) viewed 3-dimensional nature pictures delivered by a virtual reality headset for 10 minutes/day, 5 days/week for 4 weeks. The attention control group (n=36) viewed 3-dimensional urban pictures (Urban-VR) delivered by a virtual reality headset at the same frequency of Nature-VR. Outcomes were: attention measured by Oral Trail Making A and Digit Span Forward; HF self-care measured by Self-care of Heart Failure Index; and HRQL measured by Minnesota Living with Heart Failure Questionnaire. Outcomes were assessed at baseline, 4, 8, 26, and 52 weeks by telephone interviews due to COVID-19 pandemic. Linear mixed models with intention-to-treat analysis were used to test effects of group, time, and group-by-time interactions. Results: Of 73 patients, 41 were women. Self-reported race was 1 Asian, 12 African American, and 60 White. Mean age was 66 years. NYHA class was I/II=33, III=30, and 10 were missing. Sixty-eight patients (93%) completed the interventions; 56 (79% of 68) had ≥ 80% adherence; 51 (70%) completed the study. In mixed models, no significant group-by-time interactions were found in attention, HF self-care, and HRQL. HF self-care (maintenance, management, symptom perception, and confidence) significantly improved over time (p &lt; .001) in both groups. There was significant improvement on symptom perception (p= .004, better in Nature-VR). HRQL showed significant group (p = .041, worse in Nature-VR) and time effects (p = .047, both groups improved). Conclusions: Although preliminary efficacy of Nature-VR compared with Urban-VR was not supported, HF self-care and HRQL improved over 52 weeks. Future testing is indicated of multimodal interventions that include Nature-VR to improve improving self-care and HRQL.