Abstract 1547: From Novice to Expert: Confidence and Activity Status Determine Heart Failure Self-Care Performance
Background: Self-care practices differ markedly in adults with heart failure (HF). We previously described HF patients as novice, expert, or inconsistent in self-care based on data from a mixed methods study. In that study, types differed in experience, skill, confidence, and attitudes.
Purpose: To validate the novice-to-expert self-care typology and identify determinants of HF self-care types.
Methods: A cross-sectional descriptive study was performed using data from 689 adults with HF (61.3±12.5 years; 36% female, LVEF 30.4±14.6; 50% NYHA class III). Self-care was defined as a naturalistic decision-making process involving behaviors used to maintain physiological stability and the response to symptoms when they occur. Two-step likelihood cluster analysis was used to classify patients into groups using all items in the Maintenance and Management scales of the Self-Care of HF Index (SCHFI). Multinomial regression was used to identify determinants of each self-care cluster, testing the influence of age, gender, LVEF, BMI, depression, hostility, perceived control, social support, activity status (Duke Activity Status Index[DASI]), and self-care confidence (SCHFI).
Results: Self-care behaviors clustered best (Schwarz’s Bayesian and Akaike’s Information Criteria) into three types; novice (n=185, 26.9%), expert (N=229, 33.2%), and inconsistent (N=275, 39.9%). The multinomial model predicting self-care cluster membership was significant (χ2=83.32, p<.001); only DASI score and SCHFI confidence score held individual significance. Higher activity levels by DASI increased the odds that patients would be inconsistent (OR=1.02–1.09) or novice (OR=1.02–1.10) in self-care. Higher levels of confidence in self-care increased the odds that patients would be expert (OR=1.04 –1.09) or inconsistent (OR=1.01–1.05) in self-care.
Conclusions: The three level typology of HF self-care was confirmed, although the group of experts was larger than found previously. Confidence in self-care may serve as a good index of patient self-care performance. Patients who have fewer limitations to daily activities may not be driven adequately to engage in HF self-care and may need assistance in developing expertise in HF self-care.