TY - JOUR
T1 - From novice to expert
T2 - Confidence and activity status determine heart failure self-care performance
AU - Riegel, Barbara
AU - Lee, Christopher S.
AU - Albert, Nancy
AU - Lennie, Terry
AU - Chung, Misook
AU - Song, Eun Kyeung
AU - Bentley, Brooke
AU - Heo, Seongkum
AU - Worrall-Carter, Linda
AU - Moser, Debra K.
PY - 2011/3
Y1 - 2011/3
N2 - Background: In a previous, small, mixed-methods study, heart failure patients were described as novice, expert, or inconsistent in self-care. In that study, self-care types differed in experience, confidence, attitudes, and skill. Objectives: The aims of this study were to validate the novice-to-expert self-care typology and to identify determinants of the heart failure self-care types. Methods: A cross-sectional descriptive study was performed using data from 689 adults with heart failure (61 ± 2.5 years; 36% female, 50% New York Heart Association class III). 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 Heart Failure Index. Multinomial regression was used to identify the determinants of each self-care cluster, testing the influence of age, gender, left ventricular ejection fraction, body mass index, depression, anxiety, hostility, perceived control, social support, activity status (Duke Activity Status Index), and self-care confidence. Results: Self-care behaviors clustered best into three types: novice (n = 185, 26.9%), expert (n = 229, 33.2%), and inconsistent (n = 275, 39.9%). The model predicting self-care cluster membership was significant (χ = 88.67, p < .001); Duke Activity Status Index score and Self-care of Heart Failure Index confidence score were the only significant individual factors. Higher activity status increased the odds that patients would be inconsistent (odds ratio [OR] = 1.02-1.09) or novice (OR = 1.02-1.10) in self-care. Higher self-care confidence increased the odds of being an expert (OR = 1.05-1.09) or inconsistent (OR = 1.01-1.05) in self-care. Discussion: The three-level typology of heart failure self-care was confirmed. Patients who have fewer limitations to daily activities may not be driven adequately to engage in heart failure self-care and may need extra assistance in developing expertise.
AB - Background: In a previous, small, mixed-methods study, heart failure patients were described as novice, expert, or inconsistent in self-care. In that study, self-care types differed in experience, confidence, attitudes, and skill. Objectives: The aims of this study were to validate the novice-to-expert self-care typology and to identify determinants of the heart failure self-care types. Methods: A cross-sectional descriptive study was performed using data from 689 adults with heart failure (61 ± 2.5 years; 36% female, 50% New York Heart Association class III). 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 Heart Failure Index. Multinomial regression was used to identify the determinants of each self-care cluster, testing the influence of age, gender, left ventricular ejection fraction, body mass index, depression, anxiety, hostility, perceived control, social support, activity status (Duke Activity Status Index), and self-care confidence. Results: Self-care behaviors clustered best into three types: novice (n = 185, 26.9%), expert (n = 229, 33.2%), and inconsistent (n = 275, 39.9%). The model predicting self-care cluster membership was significant (χ = 88.67, p < .001); Duke Activity Status Index score and Self-care of Heart Failure Index confidence score were the only significant individual factors. Higher activity status increased the odds that patients would be inconsistent (odds ratio [OR] = 1.02-1.09) or novice (OR = 1.02-1.10) in self-care. Higher self-care confidence increased the odds of being an expert (OR = 1.05-1.09) or inconsistent (OR = 1.01-1.05) in self-care. Discussion: The three-level typology of heart failure self-care was confirmed. Patients who have fewer limitations to daily activities may not be driven adequately to engage in heart failure self-care and may need extra assistance in developing expertise.
KW - activity status
KW - confidence
KW - heart failure
KW - self-care
UR - http://www.scopus.com/inward/record.url?scp=79952537826&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952537826&partnerID=8YFLogxK
U2 - 10.1097/NNR.0b013e31820978ec
DO - 10.1097/NNR.0b013e31820978ec
M3 - Article
C2 - 21317825
AN - SCOPUS:79952537826
SN - 0029-6562
VL - 60
SP - 132
EP - 138
JO - Nursing research
JF - Nursing research
IS - 2
ER -