The Actor-partner Effects Of Associated Factors On Self-care In Patients With Chronic Heart Failure And Family Caregivers

ObjectiveThe purpose of this study was to explore the actor-partner effects of individual,binary and social factors related to chronic heart failure(CHF)patients and family caregivers on self-care of patients and family caregivers’ contribution to self-care based on the theory of dyadic illness management as well as the Actor-Partner Interdependence Model.MethodsConvenience sampling was conducted to recruit 206 dyads of hospitalized patients with CHF and their family caregivers from two tertiary hospitals in Qingdao between July 2021 and July 2022.The data were collected with a self-designed general information questionnaire,the Heart Failure Knowledge Test,the Chinese version of Zimer’s perceived social support scale,mutuality scale,the Self-Care of Heart Failure Index and the Caregiver Contribution to Self-care of Heart Failure Index.SPSS 22.0 were used to analyze the data and AMOS 24.0 were used to construct a structural equation model for the factors influencing self-care of patients with CHF and family caregivers’ contribution to self-care.Results1.The mean scores for self-care management and self-care maintenance in CHF patients were 50.00±8.16 and 49.99±9.45,respectively;the mean scores for family caregivers’ contribution to self-care management and self-care maintenance were 51.40±9.96 and 51.61±12.29,respectively.There were no significant differences in scores for bose self-care management and maintenance between CHF patients and their family caregivers(all P>0.05).2.Relationships between general characteristics and self-care in patients with CHF and their family caregivers(1)Age was negatively correlated with self-care among CHF patients,and patients who had a higher NYHA class,longer disease course and more hospitalization times due to heart failure scored lower on self-care.(2)Age was negatively correlated with contribution to self-care among family caregivers,and family caregivers who were female,educated below primary school,taking care of patients less than 6 hours one day,had monthly incomes less than 1,000 RMB scored lower on their contribution to self-care.3.Relationships between individual,binary,and society related factors and self-care in patients with CHF and their family caregivers(1)The self-care of CHF patients were positively correlated with family caregivers’ contribution to self-care.Scores for heart failure knowledge,social support,mutuality and self-care confidence in CHF patients were positively correlated with those of family caregivers.(2)Scores for knowledge of heart failure,social support,mutuality and self-care confidence were positively correlated with scores for self-care among CHF patients.Scores for knowledge of heart failure,social support,mutuality and self-care confidence were positively correlated with scores for contribution to self-care among family caregivers.(3)Scores for knowledge of heart failure,mutuality and self-care confidence of patients with CHF were positively correlated with scores for family caregivers’ contribution to self-care.Scores for knowledge of heart failure,social support,mutuality and self-care confidence of family caregivers were positively correlated with scores for self-care of CHF patients.4.Multiple regression of self-care in patients with CHF and family caregivers(1)Factors associated with the self-care among CHF patients were NYHA classⅡ/Ⅲ/Ⅳ,knowledge level of heart failure,self-care confidence and mutuality.These variables explained 33.4% of the variance in self-care.(2)Factors associated with family caregivers’ contribution to self-care were age,knowledge level of heart failure and confidence of contribution to self-care.These variables explained 25.8% of the variance in contribution to self-care.5.The actor-partner effects of associated factors on self-care in patients with chronic heart failure and their family caregivers(1)Actor effcetsThe knowledge level of heart failure,social support and self-care confidence of patients with CHF can positively predict their self-care;the knowledge level of heart failure,mutuality and confidence of contribution to self-care of family caregivers can positively predict their contribution to self-care.(2)Partner effectsThe knowledge level of heart failure,mutuality,self-care confidence of patients with CHF can positively predict family caregivers’ contribution to self-care;the knowledge level of family caregivers can positively predict self-care of CHF patients.Conclusion1.The self-care in patients with CHF and family caregivers are positively correlated with each other,and both of them need to be improved.2.Factors influencing the self-care among CHF patients were educational level,NYHA class,knowledge of heart failure and self-care confidence.3.Family caregivers’ self-care contribution is influenced by several factors including their age,gender,knowledge of heart failure,and confidence in self-care.4.Both the self-care of chronic heart failure patients and the self-care contribution of family caregivers are affected by their knowledge level of the disease,while social support impacts only the patient’s self-care and dependency relationships affect only the self-care contributions of caregivers.Additionally,the self-care confidence of patients affects both their own self-care and the self-care contribution of caregivers,whereas the knowledge of heart failure of caregivers only influences their own self-care contribution.5.To improve the health outcomes of both patients and family caregivers,clinical medical staff should prioritize the close relationship between them and consider multiple factors.They should also incorporate family caregivers into the patient’s care plan and provide home-centered health education models.