A Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-care

Generic and disease-specific caregiver contribution to self-care in a population with multiple chronic conditions: A comparative study

AIM

Describe and compare generic and disease-specific caregiver contribution (CC) to self-care behaviours in the dimensions of self-care maintenance, self-care monitoring and self-care management in multiple chronic conditions (MCCs).

DESIGN

Multicentre cross-sectional study.

METHODS

We enrolled caregivers of patients with MCC, from April 2017 to November 2022, if they were (a) 18 years of age or older and (b) identified by the patient as the principal unpaid informal caregiver. The Caregiver Contribution to Self-Care of Chronic Illness Inventory, Caregiver Contribution to Self-Care of Heart Failure Index, Caregiver Contribution to Self-Care of COPD Inventory and Caregiver Contribution to Self-care of Diabetes Inventory were used to measure generic and disease-specific contribution to patient self-care. Descriptive statistics, Student's t-tests and Pearson's correlation coefficients were used.

RESULTS

We found adequate generic CC for self-care monitoring but inadequate CC in self-care maintenance and management. All CC to disease-specific self-care maintenance, monitoring and management scales' scores were inadequate, except for caregivers of diabetic patients in which we observed an adequate score in the CC to self-care maintenance and self-care management scales in those practice insulin therapy.

CONCLUSION

Caregivers experience difficulties in performing behaviours of contribution to their patients affected by chronic conditions. Caregivers of patients with MCCs contribute more to self-care in aspects related to provider prescriptions and less to lifestyle changes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Healthcare professionals have to know in which behaviours caregivers show gaps and reflect on the reasons for poor CC to self-care to develop interventions to enhance these behaviours.

IMPACT

This study underlines the importance of choosing the most appropriate instrument for measuring CC to self-care, considering the caregiver's characteristics.

REPORTING METHOD

We adhered to STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Caregivers of patients affected by MCCs were enrolled.

Self-care behaviours and their determinants in people affected by coronary heart disease

OBJECTIVE

To describe self-care in Italian adults with coronary heart disease and to identify sociodemographic and clinical determinants of self-care.

DESIGN

This is a cross-sectional analysis of data from the Italian multicentre longitudinal study.

METHODS

We used the follow instruments: Self-Care of coronary heart disease inventory, Self-care Self Efficacy Scale, Charlson Comorbidity Index and Sociodemographic questionnaire. Descriptive statistics including absolute numbers, percentages, means and standard deviations were used to describe the sociodemographic and clinical characteristics of the sample, and the items. A structural equation model was fitted to understand sociodemographic and clinical variables associated with self-care, and possible effects mediated by self-efficacy.

RESULTS

We enrolled 427 patients. Self-care maintenance, monitoring, management and self-care self-efficacy means scores were 58.27 (SD = 20.07), 48.53 (SD = 26.97), 65.34 (SD = 22.85) and 77.16 (SD = 20.76), respectively. Except for the self-care self-efficacy scale, all the scores lay below the cut off 70 for adequacy. Older age, higher comorbidities, a higher number of stents placed, and the presence of a caregiver predicted poor self-care.

CONCLUSION

Self-care in Italian CHD populations is poor. Several associations were found between the dimensions of self-care and sociodemographic factors. Implications for the profession these findings are important for health care providers to plan interventions to improve self-care behaviour.

IMPACT

The study addressed self-care behaviours of coronary heart disease patients. Self-care was poor in this population; several associations were found between the dimensions of self-care and sociodemographic and clinical determinants. Our results can be used to support health professionals in planning interventions to improve specific self-care domains.

REPORTING METHOD

STROBE checklist was followed.

Psychometric testing of the caregiver contribution to self-care of coronary heart disease inventory

BACKGROUND

Caregivers are important contributors to the self-care of patients with coronary heart disease (CHD).

AIMS

The aims of this study are to describe the development and psychometric properties of the caregiver contribution to self-care of coronary heart disease inventory (CC-SC-CHDI).

METHODS

The CC-SC-CHDI was developed from the patient version of the scale, the Self-care of Coronary Heart Disease Inventory (SC-CHDI) and translated into Italian using forward and backward translation. Baseline data from the HEARTS-IN-DYADS study were used. Confirmatory factor analysis (CFA) was conducted to assess factorial validity; Cronbach's alpha and the model-based internal consistency index were used to test internal consistency reliability, and Pearson's correlation coefficient was used to test convergent validity, by investigating the association between the CC-SC-CHDI and the SC-CHDI scores.

RESULTS

We included 131 caregivers (mean age 55 years, 81.2% females, 74% married) of patients affected by CHD (mean age 66 years, 80.2% males, 74% married). The CFA confirmed two factors in the caregiver contribution to self-care maintenance scale ("consulting behaviors" and "autonomous behaviors"), one factor for the CC to self-care monitoring scale, and two factors in the CC to self-care management scale ("consulting behaviors and problem-solving behaviors"). Reliability estimates were adequate for each scale (Cronbach's alpha and model-based internal consistency indexes ranging from 0.73 to 0.90). Significant and positive correlations were observed between CC-SC-CHDI and SC-CHDI scales.

CONCLUSION

The CC-SC-CHDI has satisfactory validity and reliability and can be used confidently in clinical settings and research to assess caregiver contributions to CHD self-care.

Contributing to self-care of a person with chronic obstructive pulmonary disease: A qualitative study of the experiences of family caregivers

AIM

To explore family caregivers' experiences of contributing to self-care of patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A qualitative description study.

METHODS

Individual semi-structured interviews were conducted face-to face, by telephone or video calls in a purposive sample of 17 family caregivers of patients with COPD recruited in Italy, and analysed through content analysis. The consolidated criteria for reporting qualitative studies (COREQ) checklist was used for study reporting.

RESULTS

Ten subcategories were derived from 106 codes grouped into three main categories: family caregiver contributions to maintaining disease stable and ensuring a normal life for patients; family caregiver contributions to disease monitoring; and family caregiver contributions to coping with disease exacerbations. Family caregivers provided practical and emotional support, and their contribution was essential to improve treatment adherence, to enable the patient to continue living a normal life, and to have access to the healthcare services. Family caregivers were constantly vigilant and monitored patients daily to detect worsening conditions, and they managed exacerbations especially when patients were unable to do it due to their critical conditions.

CONCLUSION

This study broadens knowledge of family caregivers' contributions to patients' self-care in COPD, describing the different ways family members provide daily care to patients and the many responsibilities they take on.

IMPACT

Family caregivers perform a variety of behaviours when supporting patients with COPD in self-care, especially when patients are more dependent and the disease more severe. Nurses should acknowledge the various contributions provided by family caregivers and develop educational interventions aiming to support them in patient care and improve patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

Researchers shared the draft study report with participants for validation and feedback. This helped to strengthen the study design and results.

The caregiver contribution to self-care of stroke inventory (CC-SCSI): evaluation of psychometric characteristics

BACKGROUND

The caregiver contribution to self-care plays an important role in improving the health outcomes of chronic patients, which needs urgent attention. However, it has been hindered by the lack of a tailored instrument that assesses the caregiver contribution to self-care of stroke.

OBJECTIVES

To test the psychometric characteristics of the caregiver contribution to self-care of stroke Inventory (CC-SCSI) in health care practice.

METHODS

Participants were recruited in Henan Province from March 2021 to October 2022, utilizing a multicenter stratified sampling approach. A 23-item self-report CC-SCSI with 3 separate scales measuring caregiver contribution to self-care maintenance of stroke, caregiver contribution to self-care monitoring of stroke and caregiver contribution to self-care management of stroke was tested for validity through discriminant validity, confirmatory factor analysis, concurrent validity and convergent validity. The reliability was tested by Cronbach's α coefficient and test-retest reliability. Qualitative data were analysed using thematic analysis. A STROBE checklist was used.

RESULTS

The three scales of the CC-SCSI exhibited good discriminant validity. Confirmatory factor analysis supported the three-factor structure of the Caregiver Contribution to Stroke Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Stroke Self-Care Monitoring scale. The moderate correlation between the CC-SCSI and the Self-Care of Stroke Inventory indicated acceptable concurrent validity. The moderate correlation between the CC-SCSI and the Caregiver Contribution to Self-Care of Chronic Illness Inventory indicated acceptable convergent validity. Cronbach's αs for the Caregiver Contribution to Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management scales ranged from 0.876 to 0.974. Test-retest reliability showed average ICC values ranging from 0.828 to 0.903 (P < 0.001).

CONCLUSIONS

The 23-item CC-SCSI presents good psychometric properties and could be used to explore the caregiver contribution to stroke self-care in health care practice and research.

Network Analysis of Dyadic Burdens, Psychological Disorders, Psychological Resilience, and Illness- or Caregiving-Related Beliefs in Patients With Chronic Heart Failure and Their Caregivers

BACKGROUND

Previous research has examined the dyadic health components consisting of dyadic burdens, psychological disorders, psychological resilience, and illness- or caregiving-related beliefs independently from each other in patients with chronic heart failure (CHF) and their caregivers, but there is a need for further insights into their interconnections.

OBJECTIVE

We aimed to explore the interconnections among dyadic health components in patients with CHF and their caregivers.

METHODS

We conducted a cross-sectional study, recruiting in a total of 355 patients with CHF and their 355 respective caregivers, totaling 710 individuals across the dyads. Assessments were conducted on symptom burden, caregiver burden, anxiety, depression, psychological resilience, perceived control, and caregiver self-efficacy. Network analysis was used regarding these constructs as nodes and their associations as edges.

RESULTS

The strongest edge weight was observed between patients' anxiety and depression, followed by caregivers' anxiety and depression. Patients' depression exhibited the strongest edge weight with dyadic burdens. Caregiver burden was independently correlated with all nodes. Patients' symptom burden had fewer associations with the nodes within the caregiver community. Patients' anxiety, depression, and psychological resilience demonstrated the strongest and most influential correlations with other nodes.

CONCLUSIONS

The findings illustrated extensive interconnections among dyadic health components in CHF dyads. These findings underscored the significance of managing and intervening with patients and caregivers as a dyadic whole. Given the strong and frequent associations of patients' anxiety, depression, and psychological resilience with other nodes in the network, interventions targeting these nodes may enhance the overall network health of CHF dyads.

Psychometric testing of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory version 2

AIM

To assess the psychometric properties of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory version 2 (CC-SC-CII-v2) among primary caregivers of individuals with any single or multiple chronic illnesses.

BACKGROUND

The instrument encompasses three scales that evaluate Caregiver Contribution to Self-Care (CC-SC) Maintenance, Monitoring and Management.

METHODS

The English version CC-SC-CII-v2 was translated and adapted for Thai context, and a cross-sectional multicenter study involved 430 caregivers from 16 primary care centres in Thailand. Structural validity, internal consistency reliability and test-retest reliability were examined.

RESULTS

The original two-factor CC-SC Maintenance scale required a re-specified model for good fit, while the CC-SC Monitoring and CC-SC Management scales fit well. The simultaneous model of three scales demonstrated satisfactory fit. The CC-SC Maintenance and CC-SC Management scales both had a composite reliability index of 0.85, with omega coefficients of 0.86 and 0.83, respectively. CC-SC Monitoring had an alpha coefficient of 0.89. The intraclass correlation coefficients ranging from 0.84 to 0.91, indicating good test-retest reliability.

CONCLUSION

The Thai CC-SC-CII-v2 is a valid and reliable instrument that can provide clinicians and investigators with an evaluation of the contributions of caregivers to the self-care of patients with chronic illnesses.

The relationship between caregiver contribution to self-care and patient quality of life in heart failure: A longitudinal mediation analysis

BACKGROUND

Patients with heart failure may experience poor quality of life due to a variety of physical and psychological symptoms. Quality of life can improve if patients adhere to consistent self-care behaviors. Patient outcomes (i.e., quality of life) are thought to improve as a result of caregiver contribution to self-care. However, uncertainty exists on whether these outcomes improve as a direct result of caregiver contribution to self-care or whether this improvement occurs indirectly through the improvement of patient heart failure self-care behaviors.

AIMS

To investigate the influence of caregiver contribution to self-care on quality of life of heart failure people and explore whether patient self-care behaviors mediate such a relationship.

METHODS

This is a secondary analysis of the MOTIVATE-HF randomized controlled trial (Clinicaltrials.gov registration number: NCT02894502). Data were collected at baseline and 3 months. An autoregressive longitudinal path analysis model was conducted to test our hypotheses.

RESULTS

We enrolled a sample of 510 caregivers [mean age = 54 (±15.44), 24% males)] and 510 patients [mean age = 72.4 (±12.28), 58% males)]. Patient self-care had a significant and direct effect on quality of life at three months (β = 0.20, p < .01). Caregiver contribution to self-care showed a significant direct effect on patient self-care (β = 0.32, p < .01), and an indirect effect on patient quality of life through the mediation of patient self-care (β = 0.07, p < .001).

CONCLUSION

Patient quality of life is influenced by self-care both directly and indirectly, through the mediation of caregiver contribution to self-care. These findings improve our understanding on how caregiver contribution to self-care improves patient outcomes.

Self-management theories, models and frameworks in patients with chronic heart failure: A scoping review

AIM

The aim of this study was to synthesize the self-management theory, model and frameworks of patients with chronic heart failure, focusing on construction process, methods and existing problems.

BACKGROUND

Although the self-management theories have been created and verified for those patients with chronic heart failure, no reviews have been performed to integrate these theories.

DESIGN

A scoping review of recent literature (without a date limit) was conducted.

METHODS

A comprehensive literature search was performed. If the study reported the construction of a self-management theory, model or framework about chronic heart failure cases, it would be included in the review.

RESULTS

Fourteen studies were included, which could be categorized into situation-specific theory, middle-range theory and other theory models (including conceptual model, hypothetic regression model and identity description model). It also includes the update and validation of theories, the situation-specific theoretical of caregiver contributions extended from situation-specific theories and the nurse-led situation-specific theory in different contexts.

CONCLUSION

Self-management might contribute to start an education programme before patients with chronic heart failure (CHF) begin their chronic disease live as an individual. Our scoping review indicates that a series of self-management theories, models and frameworks for CHF patients have been developed, but more studies are still needed to validate and support these theories according to their cultural contexts.

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

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Feasibility, acceptability, and outcome responsiveness of the SYMPERHEART intervention to support symptom perception in persons with heart failure and their informal caregivers: a feasibility quasi-experimental study

BACKGROUND

Symptom perception is an important process of heart failure (HF) self-care that persons with HF need in order to master self-care management. It also leads to better patient outcomes. Symptom perception consists of body observation and analysis, which are both challenging. We aimed to test the feasibility, acceptability, and outcome responsiveness of a novel intervention (SYMPERHEART) delivered to persons with HF with their informal caregiver.

METHODS

We designed SYMPERHEART as a complex evidence-informed education and support intervention targeting body observation and analysis. We conducted a feasibility quasi-experimental study with a single group pre-post-test design. We included three subsamples: persons with HF receiving home-based care, their informal caregivers exposed to SYMPERHEART, and home-care nurses who delivered SYMPERHEART during 1 month. We assessed feasibility by recruitment time, time to deliver SYMPERHEART, eligibility rate, and intervention fidelity. We assessed acceptability by consent rate, retention rate, persons with HF engagement in body observation, and treatment acceptability. Outcome responsiveness was informed by patient-reported (PRO) and clinical outcomes: HF self-care and the informal caregivers' contribution to HF self-care, perception of HF symptom burden, health status, caregivers' burden, and HF events. We performed descriptive analyses for quantitative data and calculated Cohen's d for PROs. A power analysis estimated the sample size for a future full-scale effectiveness study.

RESULTS

We included 18 persons with HF, 7 informal caregivers, and 9 nurses. Recruitment time was 112.6 h. The median time to deliver SYMPERHEART for each participant was 177.5 min. Eligibility rate was 55% in persons with HF. Intervention fidelity revealed that 16 persons with HF were exposed to body observation and analysis. Consent and retention rates in persons with HF were 37.5% and 100%, respectively. Participants engaged actively in symptom and weight monitoring. Treatment acceptability scores were high. Symptom perception and informal caregivers' contribution to symptom perception were found to be responsive to SYMPERHEART. We estimate that a sample size of 50 persons with HF would be needed for a full-scale effectiveness study.

CONCLUSIONS

SYMPERHEART was found to be feasible and acceptable. This feasibility study provides information for a subsequent effectiveness study.

TRIAL REGISTRATION

ISRCTN. ISRCTN18151041 , retrospectively registered on 4 February 2021, ICTRP Search Portal.

A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers

Objectives

To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers.

Methods

We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs).

Results

The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales.

Conclusions

The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.

The impact of informal caregivers' preparedness on short-term outcomes of heart failure patients with insufficient self-care

AIMS

Even though self-care is essential in the long-term management of heart failure (HF), it is often not performed adequately in HF populations. Mobilizing informal caregivers may be one way to help patients perform self-care, support individual needs, and maintain health. However, informal caregivers often face insufficient preparation for providing long-term care. This insufficient caregiver preparedness may lead to a decline in caregiver contributions and affect the outcomes of care in patients with HF. This study aimed to explore whether informal caregivers' preparedness is a predictor that influences short-term outcomes of HF patients; to analyse whether caregiver contribution to self-care of HF (CC-SCHF) plays a mediating role between informal caregivers' preparedness and HF short-term outcomes.

METHODS AND RESULTS

A prospective observational study was conducted in China. After controlling for covariates, higher levels of informal caregivers' preparedness were significantly associated with lower 3-month mortality [odds ratio (OR) = 0.919, 95% confidence interval (CI) = (0.855-0.988), P = 0.022] and 3-month readmission rate [OR = 0.883, 95% CI = (0.811-0.961), P = 0.004] and shorter length of hospital stay (β = -0.071, P < 0.001). The informal caregiver's preparedness was positively associated with CC-SCHF maintenance (r = 0.708, P < 0.01), CC-SCHF management (r = 0.431, P < 0.01), and CC-SCHF confidence (r = 0.671, P < 0.01). The CC-SCHF management was a mediator in the relationship between informal caregivers' preparedness and 3-month readmission rate [effect 95% CI = (-0.054 to -0.001)] and length of hospital stay [effect 95% CI = (-0.235 to -0.042)].

CONCLUSION

A higher level of informal caregivers' preparedness is associated with better short-term outcomes of HF patients with insufficient self-care.

Validity and Reliability of Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease Inventory and Caregiver Self-Efficacy in Contributing to Self-Care Scale

The study tested the construct validity and reliability of the Caregiver Contribution to Self-Care of Chronic Obstructive Pulmonary Disease (COPD) Inventory and the Caregiver Self-Efficacy in Contributing to Self-Care of COPD Scale. The two instruments were developed by modifying the Self-Care of COPD Inventory and Self-Care Self-Efficacy Scale in COPD into caregiver versions. The psychometric properties were tested in a convenience sample of 261 informal caregivers of COPD patients recruited in Italy in two cross-sectional studies. Structural validity was tested by confirmatory factor analysis, construct validity by posing several hypotheses, and internal consistency through factor score determinacy and global reliability index for multidimensional scales. In confirmatory factor analysis, the caregiver contribution to self-care maintenance, monitoring and management scales, composing the Caregiver Contribution to Self-Care of COPD Inventory, presented good fit indices. Global reliability indices ranged 0.75-0.88. The caregiver self-efficacy scale presented a comparative fit index of 0.96 and a global reliability index of 0.82. The caregiver contribution to self-care and the caregiver self-efficacy scales correlated moderately among themselves and with the patient versions of the scales, and scores were higher with caregiver-oriented dyadic care types and female caregivers. Our study provides evidence of the two instruments' construct validity and internal consistency.

The influence of patient and caregiver depression on patient self-care and caregiver contribution to self-care in ostomy: A dyadic analysis

AIMS AND OBJECTIVES

To explore the association between patient and caregiver depression and patient self-care and caregiver contribution to self-care in the context of ostomy care.

BACKGROUND

Self-care is essential for ostomy patients and their caregivers. The ostomy self-care process can be considered a dyadic phenomenon in which the patient and the caregiver interact together and work as a team. The presence of depressive symptoms may limit the patient's ability to perform self-care and caregivers' abilities to engage in caregiving tasks. Research into the dyadic influence of depression on self-care behaviours from the perspective of ostomates and their caregivers is still in its infancy.

DESIGN

Secondary analysis of a multicentre, cross-sectional study. The STROBE checklist was used to report the present study.

METHODS

Patient-caregiver dyads were recruited from eight ostomy outpatient clinics from February 2017 to May 2018. Depression was assessed with the nine-item Patient Health Questionnaire in both patients and caregivers. Patient self-care was evaluated with the Ostomy Self-Care Index, and caregiver contribution to self-care was assessed with the Caregiver Contribution to Ostomy Self-Care Index. Both instruments measure the dimensions of maintenance, monitoring and management. The actor-partner interdependence model was performed for the dyadic analysis.

RESULTS

In total, 252 patient-caregiver dyads (patients: 69.8% male, mean age 70.05; caregivers: 80.6% female, mean age 58.7) were enrolled. Patient depression was positively associated with caregiver contribution to self-care maintenance. Caregiver depression was negatively associated with self-care management.

RELEVANCE TO CLINICAL PRACTICE

These findings add a better understanding of the reciprocal influence of dyadic depression on patient and caregiver contributions to self-care in ostomy contexts was found. Patient and caregiver depression influence patient self-care and caregiver contribution to self-care. Therefore, clinicians should assess and treat depression in both members of the dyad to improve self-care.

Perception and Challenges of Time Management for Caregivers of People with Heart Failure: A Qualitative Study

BACKGROUND

Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF.

OBJECTIVES

The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF.

METHODS

Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis.

RESULTS

We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8) years and were mostly female (84%). They dedicated 31.2 (SD, 21.7) hours per week to providing caring activities for their patients. After extracting 33 codes from their qualitative interview data, we summarized them into 8 categories and identified 4 main themes: (1) time for yourself, (2) house management, (3) time for the patient (dedicated to directing care), and (4) time for own socialization.

CONCLUSION

Caregivers navigate the complexity of time management by balancing dedicated time for supporting patients with HF and their own personal time.

Dyadic Archetypes of Patient Self-Care and Caregiver Contribution to Self-Care in Dyads With Multiple Chronic Conditions: An Observational Study

Self-care of multiple chronic conditions (MCCs) and caregiver contribution to self-care have been theorized as dyadic. However, the different dyadic archetypes are still unknown. This cross-sectional study aimed to identify dyadic archetypes related to how in patient-caregiver dyads manage the patient's MCCs and to describe other ways in which the dyadic archetypes differ. A sample of 340 MCCs patient-caregiver dyads was enrolled in outpatient and community settings. Patients had a mean age of 76.7 (±7.3) years and were mostly female (54.5%). Caregivers had a mean age of 54.6 (±15.1) years and were mostly female (71.5%). Four dyadic archetypes were observed: "autonomous," "compensatory," "balanced," and "complementary" care. Clinical programs should consider the different characteristics of dyads to support self-care.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.

The Impact of an Intervention to Improve Caregiver Contribution to Heart Failure Self-care on Caregiver Anxiety, Depression, Quality of Life, and Sleep

BACKGROUND

Better caregiver contribution to self-care in heart failure is associated with better patient outcomes. However, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep.

OBJECTIVE

The aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep.

METHODS

This is a secondary outcome analysis of the MOTIVATE-HF trial. Patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). Data were collected between June 2014 and October 2018. The article has been prepared following the Consolidated Standards of Reporting Trials checklist.

RESULTS

A sample of 510 patient-caregiver dyads was enrolled. Over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms.

CONCLUSIONS

Motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. Thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings.

Validity and reliability of the Korean caregiver contribution to self-care chronic illness inventory

The contribution of caregivers to self-care for chronically ill patients is important for improving patient outcomes. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) has been used to assess caregivers' contributions to three distinct aspects of self-care (maintenance, monitoring, and management) globally. This study aimed to examine the psychometrics of the Korean version of the CC-SC-CII with 230 family caregivers (mean age = 49.8 years, 70% women) of patients with chronic illness. We demonstrated that the CC-SC-CII-Korean has good reliability with acceptable internal consistency and construct validity for all three factors using confirmatory factor analysis. The CC-SC-CII-Korean is a reliable and valid instrument to measure the contributions of Korean caregivers to the self-care of patients with chronic illnesses.

Remote motivational interviewing to improve patient self-care and caregiver contribution to self-care in heart failure (REMOTIVATE-HF): Rationale, design, and methodology for a multicentre randomized controlled trial

In patients with heart failure (HF), self-care, and caregiver contribution to self-care (i.e., the daily management of the disease by patients and caregivers) are essential for improving patient outcomes. However, patients and caregivers are often inadequate in their self-care and contribution to self-care, respectively, and struggle to perform related tasks. Face-to-face motivational interviewing (MI) effectively improves self-care and caregiver contribution to self-care, but the evidence on remote MI is scarce and inconclusive. The aims of this randomized controlled trial will be to evaluate whether remote MI performed via video call in patients with HF: (1) is effective at improving self-care maintenance in patients (primary outcome); (2) is effective for the following secondary outcomes: (a) for patients: self-care management, self-care monitoring, and self-efficacy; HF symptoms; generic and disease-specific quality of life; anxiety and depression; use of healthcare services; and mortality; and (b) for caregivers: contribution to self-care, self-efficacy, and preparedness. We will conduct a two-arm randomized controlled trial. We will enroll and randomize 432 dyads (patients and their informal caregivers) in Arm 1, in which patients and caregivers will receive MI or, in Arm 2, standard care. MI will be delivered seven times over 12 months. Outcomes will be assessed at baseline and 3 (primary outcome), 6, 9, and 12 months from enrollment. This trial will demonstrate whether an inexpensive and easily deliverable intervention can improve important HF outcomes. With the restrictions on in-person healthcare professional interventions imposed by the COVID-19 pandemic, it is essential to evaluate whether MI is also effective remotely.

Better Preparation and Training Determine Home Care Workers' Self-Efficacy in Contributing to Heart Failure Self-Care

OBJECTIVE

Identify determinants of home care workers' (HCW) self-efficacy in contributing to heart failure (HF) self-care.

METHODS

Secondary analysis of a survey (n = 328) examining characteristics of HCWs caring for adults with HF in New York. Self-efficacy assessed using Caregiver Self-Efficacy in Contributing to Self-Care Scale. Standardized scores range 0-100; ≥ 70 points indicate adequate self-efficacy. Characteristics determined by self-efficacy (low vs. adequate). Prevalence ratios with 95% confidence intervals (PR [95% CI]) were estimated using multivariable Poisson regression with robust standard errors.

RESULTS

Home care workers with adequate self-efficacy had at least some prior HF training (55% vs. 17%, p < .001) and greater job satisfaction (90% vs. 77%, p = .003). Significant determinants for adequate self-efficacy were employment length (1.02 [1.00-1.03], p = .027), preparation for caregiving (3.10 [2.42-3.96], p < .001), and HF training (1.48 [1.20-1.84], p < .001).

CONCLUSION

Home care agencies and policy-makers can target caregiving preparation and HF training to improve HCWs' confidence in caring for adult HF patients.

Partners' Experience of Informal Caregiving for Patients With Heart Failure: A Meta-ethnography

BACKGROUND

Individuals with heart failure (HF), a debilitating disease with ongoing adaptation and management, are often cared for by partner caregivers whose needs and voices are overshadowed by the demands of HF management. With multidimensional needs and complex challenges for individuals with HF, partner caregivers have to deal with uncertainty and need guidance. Given the vital role of partners, attention should be drawn toward understanding the experience of HF partner caregivers.

OBJECTIVE

The aim of this study was to synthesize existing qualitative evidence related to caregivers' views and experiences of caring for their partners with HF. This knowledge would assist healthcare providers to better meet the demand of partners and provide them with effective guidance.

METHODS

A meta-ethnography of qualitative evidence was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations for reporting systematic reviews. A comprehensive search of PubMed, Scopus, ISI Web of Science, CINAHL, PsycINFO, and EMBASE, as well as hand searches of the reference lists from included articles, was conducted. A combination of subject terms including MeSH and keywords related to HF, partner experience, and qualitative methods was used to identify studies. Studies were included if they were published in English between January 2000 and December 2020 and examined caregivers' experiences in providing care for their partner with HF by using qualitative methods.

RESULTS

Ten articles were included, with 178 participants, and most partners were female. Five studies were conducted in the United States, and 4 studies were conducted in Sweden. Five studies reported partners' health problems; 8 of the studies delineated the inclusion and exclusion criteria for partners. Five overarching themes emerged: shouldering the responsibility, being overloaded, bearing emotional burdens, staying positive, and "left in the dark," craving support from others.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Given the complex roles in caring for individuals with HF, more qualitative research is strongly warranted to enhance caregivers' support and education. A deeper and more comprehensive understanding of the experiences of caregivers for partners with HF is essential for developing tailored interventions. Healthcare providers should be aware of the importance of ongoing assessment and evaluate partner caregivers' needs and assist them in providing more information and formulating coping strategies as required.

Caregivers’ contribution to self-care for patients treated with oral anticancer agents: A qualitative descriptive study

PURPOSE

To adequately manage oral anticancer agents (OAAs) therapy, appropriate self-care behaviours must be implemented. Informal caregivers could support and contribute to patient self-care. This study aimed to explore and describe the caregiver contribution to self-care and their related experience of caring among informal caregivers of patients on OAAs.

METHODS

Qualitative descriptive design. We conducted semi-structured interviews, which were transcribed, read in depth, and analysed with deductive and inductive content analysis, according to Mayring. Adult informal caregivers (>18 years) of elderly patients (>65 years) with solid malignancies undergoing OAAs therapy for at least 3 months were included.

FINDINGS

Twenty-three caregivers were interviewed with mean age of 57,2 (SD ± 15,8). A total of 18 codes from the qualitative content analysis were found, of which ten were referred to caregiver contribution and classified into the three dimensions of self-care maintenance (i.e. behaviours to maintain illness stable), self-care monitoring (i.e., tracking symptoms and side effects), and self-care management (i.e., management of worsening symptoms), according to the Middle Range Theory of Self-Care of Chronic Illnesses. The eight codes on caregiver experience were aggregated into two main themes: negative aspects (i.e., burden, emotional state, self-denial, social isolation) and positive aspects of caregiving.

CONCLUSION

Healthcare professionals should consider the importance of caregiver role in supporting their loved one treated with OAAs, also taking into account their needs to prevent burdensome situations. A holistic view in which a patient-centred approach is established should be encouraged through the communication and education of the dyad.

Factors Related to Patients' Self-care and Self-care Confidence in Korean Patients With Heart Failure and Their Caregivers: A Cross-sectional, Correlational Study

BACKGROUND

The relationships of patient factors and caregiver contribution to patients' self-care to different types of self-care have been rarely examined in Korean patients with heart failure.

OBJECTIVE

The aim of this study was to examine patient (ie, age, depressive symptoms, and self-care confidence) and caregiver (ie, caregiver contribution to self-care maintenance and self-care management, and caregiver confidence in contributing to self-care) factors related to different types of self-care (ie, self-care maintenance, symptom perception, and self-care management) and self-care confidence in Korean patients with heart failure.

METHODS

In this cross-sectional, correlational study, data from 41 pairs of patients (mean age, 68.0 years) and caregivers (mean age, 54.1 years) were collected and analyzed using multiple regression.

RESULTS

Higher levels of self-care confidence in patients were related to higher levels of self-care maintenance in patients. Higher levels of self-care confidence in patients were related to higher levels of symptom perception. Higher levels of self-care confidence in patients and caregiver contribution to self-care maintenance were related to higher levels of self-care management. Less severe depressive symptoms in patients and higher levels of caregiver confidence in contributing to self-care were related to higher levels of self-care confidence.

CONCLUSION

Different patient and caregiver factors were related to different types of self-care and self-care confidence in Korean patients, but patients' self-care confidence was related to all types of self-care. Clinicians and researchers need to develop and deliver effective interventions to both patients and their caregivers to improve patients' self-care confidence and, in turn, self-care, considering different factors associated with each type of self-care.

The Influence of Informal Caregivers' Preparedness on Psychological Symptoms and Quality of Life Among Patients With Heart Failure And Insufficient Self-care

BACKGROUND

Most patients with heart failure find self-care difficult to perform and rely on family caregivers for support. Informal caregivers, however, often face insufficient psychological preparation and challenges in providing long-term care. Insufficient caregiver preparedness not only results in psychological burden for the informal caregivers but may also lead to a decline in caregiver contributions to patient self-care that affects patient outcomes.

OBJECTIVE

Our objective was to test (1) the association of baseline informal caregivers' preparedness with psychological symptoms (anxiety and depression) and quality of life 3 months after baseline among patients with insufficient self-care and (2) the mediating effects of caregivers' contributions to self-care of heart failure (CC-SCHF) on the relationship of caregivers' preparedness with patients' outcomes at 3 months.

METHODS

A longitudinal design was used to collect data between September 2020 and January 2022 in China. Data analyses were conducted using descriptive statistics, correlations, and linear mixed models. We used model 4 of the PROCESS program in SPSS with bootstrap testing to evaluate the mediating effect of CC-SCHF of informal caregivers' preparedness at baseline with psychological symptoms or quality of life among patients with HF 3 months later.

RESULTS

Caregiver preparedness was positively associated with CC-SCHF maintenance (r = 0.685, P < .01), CC-SCHF management (r = 0.403, P < .01), and CC-SCHF confidence (r = 0.600, P < .01). Good caregiver preparedness directly predicted lower psychological symptoms (anxiety and depression) and higher quality of life for patients with insufficient self-care. The associations of caregiver preparedness with short-term quality of life and depression of patients with HF with insufficient self-care were mediated by CC-SCHF management.

CONCLUSIONS

Enhancing the preparedness of informal caregivers may improve psychological symptoms and quality of life of heart failure patients with insufficient self-care.

Self-care in coronary heart disease patient and caregiver dyads (HEARTS-IN-DYADS)-Protocol of a multicenter longitudinal study

Self-care performed by patients and the caregiver contribution to this self-care are essential for improving cardiovascular outcomes; however, so far, no studies have sufficiently investigated this field in Italy. This paper describes a research protocol of a multi-center longitudinal study designed to investigate the self-care of patients affected by coronary heart disease (CHD), the caregiver's contribution to this self-care, the predictors of patient and caregiver self-care, the mediating role of self-efficacy, and the self-care outcomes. Data collection will be performed across seven Italian inpatient settings at baseline and 3 and 6 months from enrollment. Multilevel modeling and actor partner interdependence models will be implemented on a sample of 330 patient-caregiver dyads to adjust for the interdependence of measurements. The study received approval from an ethics committee in Italy and was financed in January 2021 by a grant from the Solidal Foundation in Alessandria. This research will advance the knowledge about the self-care process in CHD. The results will guide research and clinical practice by identifying variables sensitive to educational interventions.

Motivational interviewing for enhancing self-care in patients with Heart Failure: protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND

Heart failure (HF) is characterized by an increasing prevalence, representing a public health problem and a significant cause of morbidity and mortality. Self-care is a cornerstone approach for optimizing therapy for patients with HF. Patients play a crucial role in managing their condition, given that several adverse health outcomes might be avoided with adequate self-care. In this regard, the literature describes motivational interviewing (MI) as highly favorable for treating chronic diseases, with promising results supporting its efficacy in enhancing self-care. Moreover, caregivers' availability constitutes a fundamental supporting factor among the strategies to improve self-care behaviors in people with HF.

OBJECTIVE

The primary study aim is to test the efficacy of a structured program, including scheduled MI interventions, in improving self-care maintenance in the 3-month follow-up from the enrollment. Secondary aims comprehend the assessment of the effectiveness of the above intervention on secondary outcomes (eg, self-care monitoring, quality of life, sleep disturbance) and the corroboration of the superiority of caregivers' participation to the intervention over the program administrated only to individual patients in enhancing self-care behaviors and other outcomes at 3, 6, 9, and 12 months from the enrollment.

METHODS

This study protocol designed a prospective, parallel-arm, open-label, 3-arm, controlled trial. The MI intervention will be administered by nurses trained in HF self-care and MI; the education program will be provided to nurses by an expert psychologist. Analyses will be performed within the framework of intention-to-treat analysis. Comparisons between groups will be based on an alpha of 5% and 2-tailed null hypotheses. In the case of missingness, analyzing the extent of the missingness and identifying underlying mechanisms and patterns will guide imputation methods.

RESULTS

The data collection was started in May 2017. We completed the data collection with the last follow-up in May 2021. We plan to perform data analysis by December 2022. We plan to publish the study results within March 2023.

CONCLUSIONS

MI enhances potential self-care practices in patients with HF and their caregivers. Although MI is effectively largely employed either alone or combined with other treatments and is administered in different settings and ways, face-to-face interventions seem to be more effective. Dyads with higher shared HF knowledge are more efficient in promoting self-care adherence behaviors. Moreover, patients and caregivers may perceive proximity with health care professionals, resulting in a better ability to follow the received health professionals' directions. The scheduled in-person meetings with patients and caregivers will be exploited to administer MI, respecting all the safety regulations for infection containment. The conduction of this study may support changes in clinical practice to include MI to improve self-care for patients with HF.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05595655; https://clinicaltrials.gov/ct2/show/NCT05595655.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44629.

The relationship between mutuality and contributions to self-care in family caregivers of patients with heart failure: multiple mediating effects of resilience and self-efficacy

AIMS

Previous studies have indicated a positive association between mutuality and caregiver contributions to heart failure self-care (CC-HFSC). However, little is known about the underlying mechanisms in the relationship. This study aimed to determine whether resilience and self-efficacy play multiple mediating roles in the association between mutuality and CC-HFSC.

METHODS AND RESULTS

In this cross-sectional, correlational study, a self-reported survey was conducted in 259 patient-caregiver dyads recruited from two hospitals in China using a convenience sampling method. Better mutuality (r = 0.27, P < 0.01), resilience (r = 0.23, P < 0.01), and self-efficacy (r = 0.34, P < 0.01) were correlated with greater CC-HFSC maintenance. Better mutuality (r = 0.29, P < 0.01), resilience (r = 0.20, P < 0.01), and self-efficacy (r = 0.35, P < 0.01) were correlated with greater CC-HFSC management. In multiple mediation models, self-efficacy independently [effect = 0.061, 95% confidence interval (CI) (0.024-0.119)] and resilience and self-efficacy serially [effect = 0.017, 95% CI (0.007-0.036)] mediated the association between mutuality and CC-HFSC maintenance. Meanwhile, self-efficacy independently [effect = 0.058, 95% CI (0.020-0.113)] and resilience and self-efficacy serially [effect = 0.018, 95% CI (0.007-0.038)] mediated the association between mutuality and CC-HFSC management.

CONCLUSIONS

Resilience and self-efficacy were multiple mediators in the association between mutuality and CC-HFSC. Interventions targeting the facilitation of mutuality, and then increasing resilience and self-efficacy may be beneficial for improving CC-HFSC.

Effectiveness of Motivational Interviewing on contribution to self-care, self-efficacy, and preparedness in caregivers of patients with heart failure: a secondary outcome analysis of the MOTIVATE-HF randomized controlled trial

AIMS

Caregiver characteristics and behaviours are associated with patients' and caregivers' outcomes. However, there is scarce evidence on interventions aimed at improving caregiver contribution (CC) to patient self-care, caregiver self-efficacy, and caregiver preparedness in heart failure (HF). This study aims to evaluate the effect of Motivational Interviewing (MI) on CC to patient self-care, caregiver self-efficacy, and caregiver preparedness in HF.

METHODS AND RESULTS

This is a secondary outcome analysis of MOTIVATE-HF randomized controlled trial. Caregivers of patients with HF were randomized into three arms: Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard care). The intervention consisted of one MI session plus three telephone contacts. Data were collected at baseline and after 3, 6, 9, and 12 months. A total of 510 patient and caregiver (median age 54 years, 76% females) dyads were enrolled, 235 caregivers and 238 patients completed the study until 12 months. Caregiver contribution to self-care maintenance and management and caregiver preparedness significantly improved over time, but without significant differences among the three arms. At 9 months, caregiver self-efficacy improved more in Arm 2 than Arm 3 [difference: 8.36, 95% confidence interval (CI) (3.13; 13.59), P = 0.001]. This improvement remained significant also at linear mixed model [β^ = 1.39, 95% CI (0.02; 2.75), P = 0.046].

CONCLUSION

Motivational Interviewing did not improve CC to patient self-care and caregiver preparedness. However, it increased caregiver self-efficacy, which is known to be a powerful mediator of CC to self-care.

REGISTRATION

Clinicaltrials.gov: NCT02894502.

Development and Piloting of a Community-Partnered Heart Failure Training Course for Home Health Care Workers

BACKGROUND

Despite their unique contributions to heart failure (HF) care, home healthcare workers (HHWs) have unmet educational needs and many lack HF caregiving self-efficacy. To address this, we used a community-partnered approach to develop and pilot a HF training course for HHWs.

METHODS

We partnered with the Training and Employment Fund, a benefit fund of the largest healthcare union in the United States, to develop a 2-hour virtual HF training course that met HHWs' job-specific needs. English and Spanish-speaking HHWs interested in HF training, with access to Zoom, were eligible. We used a mixed methods design with pre/postsurveys and semi-structured interviews to evaluate the course: (a) feasibility, (b) acceptability, and (c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale range 0-100]).

RESULTS

Of the 210 HHWs approached, 100 were eligible and agreed, and 70 enrolled. Of them, 53 (employed by 15 different home care agencies) participated. Posttraining data showed significant improvements (pretraining mean [SD] versus posttraining mean [SD]; P value) in HF knowledge (11.21 [1.90] versus 12.21 [1.85]; P=0.0000) and HF caregiving self-efficacy (75.21 [16.57] versus 82.29 [16.49]; P=0.0017); the greatest gains occurred among those with the lowest pre-training scores. Participants found the course engaging, technically feasible, and highly relevant to their scope of care.

CONCLUSIONS

We developed and piloted the first HF training course for HHWs, which was feasible, acceptable, and improved their HF knowledge and caregiving self-efficacy. Our findings warrant scalability to the workforce at large with a train-the-trainer model.

Time to Revisit Heart Failure Self-Care: A Concept Analysis

Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger's evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviors to the detriment of social and structural determinants of health. It also shifts responsibility away from the health care system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self .

Factors associated with caregivers' contribution to self-care in heart failure

OBJECTIVE

to analyze the caregiver's contribution to self-care in heart failure and the predictor variables of this contribution.

METHOD

a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution.

RESULTS

the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient's medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver's confidence in contributing to self-care were predictors of caregiver's contribution to maintenance or management self-care.

CONCLUSION

the caregiver's contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver's confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Patient Self-Care and Caregiver Contribution to Patient Self-Care of Chronic Conditions: What Is Dyadic and What It Is Not

OBJECTIVES

Self-care of chronic conditions involves both patients and their informal caregivers and therefore might be considered as a dyadic phenomenon. Nevertheless, empirical evidence supporting a dyadic construct is unavailable. This study aimed to explore the existence of a dyadic construct in self-care maintenance, monitoring, and management in patients affected by chronic conditions and their informal caregivers.

METHODS

This study used a cross-sectional design. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory, which measure patient self-care and informal caregivers' contribution to self-care maintenance, monitoring and management. Exploratory Structural Equation Modeling was performed to verify the existence of dyadic latent constructs in each scale in patients and informal caregivers.

RESULTS

A convenience sample of 493 patients and informal caregivers, with a mean age of 76.47 and 52.76 years, respectively, was studied. In the self-care maintenance scales, 2 correlated factors (r = 0.34, P < .001) were identified, indicating the presence of a dyadic second-order construct. In addition, 2 factors that were not correlated (r = 0.11, P = .064) were identified in the self-care monitoring scales, indicating the absence of a dyadic construct. Finally, we found a 3-factor model in the self-care management scales composed of both patient and caregiver items, indicating a dyadic first-order construct.

CONCLUSIONS

Knowing which care behaviors are dyadic in chronic conditions is important for tailoring interventions to improve self-care. Self-care maintenance and management would benefit from dyadic interventions, while self-care monitoring would not. The results of this study may illuminate future theoretical and scientific developments in dyadic care of chronic illness.

Needs and problems related to sociodemographic factors of informal caregiving of people with heart failure: A mixed methods study in three European countries

AIMS

To explore caregivers' needs and problems in three European countries and associate the clusters of caregivers' needs with their sociodemographic characteristics.

DESIGN

A qualitative focused mixed methods design was used.

METHODS

In total, 52 caregivers of heart failure (HF) people were interviewed in three European countries between March 2017 and December 2018. Transcripts were analysed using the seven-phase method of the exploratory multidimensional analysis according to Fraire with Reinert lexical classes findings were organized in dendrograms. Mayring's content analysis was also performed.

RESULTS

Three clusters of caregivers were identified: spouses, adult children and non-family members. Caregivers not only provide HF patients with vital unpaid support for their physical and emotional needs, but they are continually trying to cope with their social isolation and deteriorating health.

CONCLUSIONS

Informal caregiving emerged as a complex process influenced by various sociodemographic factors. Gender, relationship type and economic status are the important factors to be considered planning to develop approaches to address the needs of caregivers serving people with heart failure.

IMPACT

A comprehensive understanding of the nature of informal caregiving of individuals with heart failure, the complexity of the real-world sociodemographic and cultural factors is warranted. The use of the EMDA method gave us the possibility of processing large masses of qualitative data through rapid, complex calculations. In detail, AATD allowed us to study in deep the significant fuzziness of what caregivers expressed and to analyse the content of the entire interviews and to produce global knowledge by using multi-dimensional statistical methods to grasp the fundamental sense of the interviews, beyond the simple words. Three clusters were identified in the samples, including spouses, adult children and non-family members. This study demonstrated that some sociodemographic characteristics could lead to everyday needs. Therefore, these demographic characteristics should be considered in developing targeted interventions. The research was conducted in Europe, but the technique shown can be replicated everywhere. The findings not only impact nursing but can be extended to all those stakeholders who concur with a public health educational mission.

PATIENT OR PUBLIC CONTRIBUTION

Carers were involved in this study after the discharge of their loved ones or at the time of the outpatient visit. They were involved after they had been observed in their dynamics of involvement in caring of the familiars or friends with heart failure.

Predictors of maternal role adaptation in Iranian women: a cross-sectional study

Background

Numerous factors play a role in maternal identity formation and function. Recognizing the aspects related to adaptation to the mother role can effectively provide a solution to help mothers construct maternal roles. Consequently, this study aimed to determine the predictors of adaptation to the maternal role in Iranian women.

Methods

This cross-sectional study was performed on 564 women who gave birth within one to four months after delivery with a record in Tabriz-Iran health centers, 2020–21. Participants were selected by cluster sampling. Data were collected using questionnaires of socio-demographic and obstetrics characteristics, Birth Satisfaction Scale-Revised (BSS-R), Lipz Maternal Self-Confidence Scale (LMSCS), and maternal role adaptation questionnaire. The general linear model was used to estimate the effect of each of the independent variables (socio-demographic and obstetrics characteristics, childbirth satisfaction, and self-confidence) on the dependent variable (maternal role adaptation).

Results

The mean (± SD) total scores of adaptation to the maternal role, childbirth satisfaction, and maternal self-confidence were 77.4 (± 15.2) (score range: 33–165), 17.0 (± 5.9) (score range: 0–40), and 65.1 (± 13.5) (score range: 24–144), respectively. Based on the Pearson correlation test, there was a significant direct correlation between the overall score of adaptation to the maternal role with childbirth satisfaction (r = 0.462, P < 0.001) and maternal self-confidence (r = 0.652, P < 0.001). Based on the adjusted general linear model, the variables of maternal self-confidence, childbirth satisfaction, adequacy of household income, and spouse support were predictors of adaptation to the mother role. They explained 50.6% of the variance in the adaptation to the mother role score.

Conclusions

Concerning the study results, adaptation to the maternal role is related to childbirth satisfaction and some socio-demographic variables. Therefore, considering the impact of maternal role on other aspects of women's life and child care, healthcare providers' and policymakers' critical role is to create positive childbirth experiences and strengthen mothers' self-confidence.

The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care

Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.

Heart Failure Care: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model (APIM)-A Scoping Review

Self-care behaviors are essential for the effective treatment of heart failure (HF), and poor self-care may lead to adverse clinical events in patients with HF. A growing body of literature addresses the need to analyze the characteristics of both patient and caregiver since they are in mutual, long-term interaction, and their reactions to events are dependent on each other. One of the most common approaches for analyzing data on HF self-care dyads is the Actor–Partner Interdependence Model (APIM). The purpose of this study was to conduct a scoping review to answer the following question: what did we learn from HF dyadic studies based on the APIM approach? Medline, Academic Search Ultimate, and CINAHL Complete databases were searched, using the terms “dyad,” “dyadic,” and “heart failure,” for studies published between 2009 and April 2021. Fifteen studies were reviewed from a pool of 106 papers. Studies using the APIM approach revealed interrelated patient and caregiver characteristics that influence self-care and explain many complex dyadic behaviors. Our analysis provided evidence that (1) APIM is a useful analytical approach; (2) a family-oriented approach can improve the functioning of a patient with HF; and (3) social support from caregivers significantly enhances patients’ adaptation to illness.

A Motivational Interviewing Intervention Improves Physical Symptoms in Patients with Heart Failure: A Secondary Outcome Analysis of the Motivate-HF Randomized Controlled Trial

CONTEXT

Heart failure (HF) patients experience high burden of physical symptoms during their disease trajectory.

OBJECTIVE

To evaluate the effects of Motivational Interviewing (MI) on the burden of physical symptoms in HF patients.

METHODS

We performed a secondary analysis of data from the MOTIVATE-HF randomized controlled trial. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) was randomly allocated to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard of care). The MI intervention consisted of one face-to-face session plus three telephone calls conducted within two months from enrollment. Symptoms' burden was assessed with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of Chest Discomfort, Dyspnea, Early and subtle and Edema. Data were collected at baseline and at 3, 6, 9, and 12 months after enrollment.

RESULTS

At 12 months, Chest Discomfort improved in Arms 1 and 2 vs Arm 3 (Δ: -8.13, 95% CI: -14.61; -1.65). Dyspnea improved in Arms 1 and 2 vs Arm 3 both at 9 and 12 months (Δ: -7, 95% CI: -13.18; -0.82 and -6.78, 95% CI: -13.19; -0.38); HFSPS total score improved in Arm 1 and Arm 2 vs Arm 3 at 9 months (Δ: -4.55, 95% CI: -9.05; -0.05). Over 1 year, Chest Discomfort and HFSPS total score in Arm 2 improved compared to Arm 3 (β= -2.61, 95% CI: -4.21; -1.00, P = 0.0015 and β=-1.35, 95% CI: -2.50; -0.21, P = 0.02).

CONCLUSION

MI reduces the burden of physical HF symptoms, particularly when caregivers are involved in the intervention.

Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer's Disease and Related Dementias: A Qualitative Study

Many older adults with diabetes (DM) have co-occurring Alzheimer's Disease (AD) and AD-Related Dementias (ADRD). Complex treatment plans may impose treatment burden for caregivers responsible for day-to-day self-management. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for people with DM-AD/ADRD. Caregivers (n = 33) of patients with DM-AD/ADRD participated in semi-structured interviews about their caregiver role and perceptions of treatment burden of DM-AD/ADRD management. Qualitative data were analyzed using content analysis (ATLAS.ti). Caregivers reported high levels of burden related to complex treatment/self-management for patients with DM-AD/ADRD that varied day-to-day with the patient's cognitive status. Four themes were: (1) trajectory of treatment burden; (2) navigating multiple healthcare providers/systems of care; (3) caregiver role conflict; and (4) emotional burden. Interventions to reduce caregiver treatment burden should include activating supportive services, education, and care coordination especially, if patient treatment increases in complexity over time.

Factores asociados a la contribución de los cuidadores para el autocuidado de la insuficiencia cardiaca

Resumen Objetivo: analizar la contribución del cuidador para el autocuidado en la insuficiencia cardiaca y las variables predictoras de esa contribución. Método: estudio transversal descriptivo y analítico, con la participación de 140 díadas (pacientes y cuidadores). La contribución para el autocuidado fue evaluada por medio del Caregiver Contribution to Self-Care of Heart Failure Index. Los cuidadores y pacientes fueron entrevistados separadamente para obtención de los datos. La regresión linear múltiple fue utilizada para verificar variables predictoras de la contribución del cuidador. Resultados: la puntuación media de contribución para el autocuidado de manutención fue 62,7 (DE=7,1), de administración fue 62,9 (DE=20,4) y de confianza fue 63,3 (DE=22,1). Las variables: número de medicamentos del paciente, cuidador tener parentesco con el paciente, percepción social del cuidador, calidad de vida relacionada a la salud del paciente y la confianza del cuidador en la contribución para el autocuidado, fueron predictoras de la contribución del cuidador para el autocuidado de manutención o de administración. Conclusión: la contribución del cuidador fue insuficiente. El apoyo social percibido por el cuidador, el cuidador tener o no parentesco con el paciente, el número de medicamentos utilizados por el paciente y la confianza del cuidador en contribuir para el autocuidado, son variables que deben ser consideradas para evaluar el riesgo de contribución insuficiente del cuidador.

The Influence of Preparedness, Mutuality, and Self-efficacy on Home Care Workers' Contribution to Self-care in Heart Failure: A Structural Equation Modeling Analysis

BACKGROUND

Home care workers (HCWs) are increasingly caring for patients with heart failure (HF). Previous studies have shown that they contribute to HF patients' care, but how their preparedness and their relationship with patients (mutuality) influence caregiving is unknown, as well as the role of HCWs' self-efficacy.

OBJECTIVE

Guided by the Situation-Specific Theory of Caregiver Contribution to HF Self-Care, we investigated the influence of HCWs' preparedness and mutuality on HCWs' contribution to HF self-care and the mediating effect of HCWs' self-efficacy in the process.

METHODS

We conducted a cross-sectional survey of HCWs who cared for patients with HF. The survey included the Caregiver Preparedness Scale, Mutuality Scale, Caregiver Contribution to Self-Care of HF Index, and Caregiver Self-Efficacy in Contributing to Self-Care Scale. We performed structural equation modeling and a mediation analysis.

RESULTS

A total of 317 HCWs employed by 22 unique home care agencies across New York, NY, completed the survey. They had a median age of 50 years, 94% were women, and 44% were non-Hispanic Black. Results demonstrated that mutuality had a direct influence on HCW contribution to self-care and preparedness influenced their contribution to self-care, but only through the mediation of self-efficacy.

CONCLUSION

Home care workers' preparedness, mutuality, and self-efficacy have important roles in influencing their contribution to HF self-care. As a workforce increasingly involved in the care of patients with HF, knowing the mechanisms underpinning HCWs' contribution to self-care may illuminate future interventions aimed at improving their contributions and HF patient outcomes.

Factors associated with caregivers’ contribution to self-care in heart failure

Objective:

to analyze the caregiver’s contribution to self-care in heart failure and the predictor variables of this contribution.

Method:

a cross-sectional descriptive and analytical study, with the participation of 140 dyads (patients and caregivers). The contribution to self-care was assessed using the Caregiver Contribution to Self-Care of Heart Failure Index. Caregivers and patients were interviewed separately to obtain the data. Multiple linear regressions were used to verify predictor variables of caregiver contribution.

Results:

the mean score for contribution to maintenance self-care was 62.7 (SD=7.1), for management, 62.9 (SD=20.4) and for confidence was 63.3 (SD=22.1). The variables number of patient’s medications, caregiver being related to the patient, social perception of caregiver, health-related quality of life of the patient and caregiver’s confidence in contributing to self-care were predictors of caregiver’s contribution to maintenance or management self-care.

Conclusion:

the caregiver’s contribution was insufficient. The social support perceived by the caregiver, the type of relationship the caregiver to the patient, the number of medications used by the patient, as well as the caregiver’s confidence in contributing to self-care are variables that should be considered to assess the risk of insufficient contribution of the caregiver.

Psychometric Characteristics of the Caregiver Contribution to Self-care of Heart Failure Index in a South American Population

BACKGROUND

Caregivers can contribute enormously to the self-care of patients with heart failure (HF). The Caregiver Contribution to Self-care of Heart Failure Index (CC-SCHFI) measures these contributions across 3 scales: self-care maintenance, which evaluates caregiver contributions to symptom monitoring and treatment adherence; self-care management, which evaluates caregiver contributions in dealing with symptoms; and caregiver confidence, which assesses caregiver self-efficacy in managing all contributions to self-care. Although the CC-SCHFI has been used in several investigations, only 1 study has evaluated its psychometric characteristics.

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the CC-SCHFI in Brazil.

METHODS

A cross-sectional design was used in this study. Confirmatory factor analysis was used to assess construct validity, and factor score determinacy coefficients were computed to evaluate internal consistency reliability.

RESULTS

The sample comprised 99 caregivers of patients with HF. Most were women (73%), with a mean age of 48 ± 14 years; 57% were patients' spouses. Confirmatory factor analysis confirmed the original factor structure of the instrument, with supportive fit indices for all 3 scales (comparative fit index, 0.95-1.00; root-mean-square error of approximation, 0.00-0.057). Reliability estimates were adequate for each CC-SCHFI scale (0.77-0.96).

CONCLUSIONS

The CC-SCHFI is a valid and reliable scale to measure caregiver contributions to self-care maintenance, caregiver contributions to self-care management, and caregiver confidence in HF.

Development and Psychometric Testing of the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale

OBJECTIVES

Caregiver self-efficacy-a caregiver's belief in his/her ability to contribute to patient self-care-is associated with better patient and caregiver outcomes in single chronic conditions. It is, however, unknown if caregiver self-efficacy improves patient and caregiver outcomes in multiple chronic conditions (MCCs) because there is no instrument to measure this variable. We developed the 10-item Caregiver Self-Efficacy in Contributing to patient Self-Care (CSE-CSC) scale for that purpose, and we tested its psychometric characteristics in caregivers of patients with MCCs.

METHODS

In this cross-sectional multisite study, we tested the structural validity of the CSE-CSC scale with exploratory and confirmatory factor analysis, and we tested construct validity by correlating CSE-CSC scores with those of the Caregiver Contributions to Self-Care of Chronic Illness Inventory. We also tested reliability, and precision of the CSE-CSC scale.

RESULTS

The 358 enrolled caregivers (mean age 54.6 years; 71.5% female) cared for patients with an average of 3.2 chronic conditions. Structural validity was good, and it showed 2 factors within the scale. Construct validity showed significant correlations between scores of the CSE-CSC scale and the Caregiver Contributions to Self-Care of Chronic Illness Inventory. Reliability coefficients were between 0.90 and 0.97. Measurement error yielded satisfactory results.

CONCLUSIONS

The CSE-CSC scale is valid, reliable, and precise in measuring caregiver self-efficacy in contributing to patient self-care in MCCs. Because caregiver self-efficacy is a modifiable variable, the CSE-CSC scale can be used in clinical practice and research to improve patient and caregiver outcomes.

Validity and Reliability of the Caregiver Contribution to Self-Care of Heart Failure Index Version 2

BACKGROUND

Lay caregivers are important in contributing to self-care of patients with heart failure (HF). The Caregiver Contributions to Self-Care of Heart Failure Index (CC-SCHFI) measures these contributions, but after developing the Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, the CC-SCHFI needed updating to reflect the theory.

OBJECTIVE

The aim of this study was to test the psychometric characteristics of the CC-SCHFI 2 that measures caregiver contributions (CC) to HF self-care with 3 scales: CC to self-care maintenance, CC to symptom perception, and CC to self-care management.

METHODS

This is a cross-sectional study. We tested the CC-SCHFI 2 with confirmatory factor analysis, internal consistency, item-total correlations, and test-retest reliability. With the CC-SCHFI 2, we also administered the Self-Care of Heart Failure Index v.7.2 to patients and the Caregiver Contribution to Heart Failure Self-Care Scale to caregivers to assess concurrent validity.

RESULTS

A sample of 277 caregivers was enrolled (mean [SD] age, 52.7 [14.9] years; 70.4% female). In confirmatory factor analysis, each CC-SCHFI 2 scale had supportive fit indices: comparative fit index ranged between 0.94 and 0.95, and root mean square error of approximation ranged between 0.05 and 0.07. Internal consistency of the 3 scales was evident with a Cronbach α between .81 and .83 and a global reliability index between 0.79 and 0.86. Item-total correlations were all greater than 0.30. In concurrent validity testing, there were significant correlations between the CC-SCHFI 2 and the Self-Care of Heart Failure Index v.7.2 and the Caregiver Contribution to Heart Failure Self-Care Scale. Test-retest reliability showed intraclass correlation coefficients between 0.72 and 0.91.

CONCLUSIONS

Testing of the CC-SCHFI 2 supported validity and reliability, indicating that the instrument can be used in clinical practice and research to evaluate CC to the self-care of patients with HF.

The Influence of Caregiver Preparedness on Caregiver Contributions to Self-care in Heart Failure and the Mediating Role of Caregiver Confidence

BACKGROUND

Caregiver contributions (CC) to heart failure (HF) self-care maintenance (ie, CC to maintaining HF stability) and management (ie, CC to dealing with HF signs and symptoms) improve patient outcomes, but it is unknown whether caregiver preparedness influences CC to self-care and whether caregiver confidence mediates this process.

OBJECTIVES

We evaluated the influence of caregiver preparedness on CC to HF self-care maintenance and management and the mediating role of caregiver confidence.

METHODS

This is a secondary analysis of the MOTIVATE-HF study. Patients were 18 years or older, with a diagnosis of HF in New York Heart Association classes II to IV, who had insufficient self-care and did not have severe cognitive impairment. Patients' informal caregivers were those people inside or outside the family who gave most of the informal care to the patients. We used the Caregiver Preparedness Scale and the Caregiver Contribution to Self-Care of HF Index. We tested a path analysis model and the indirect effects.

RESULTS

Caregivers (n = 323) were 55 (SD, 15) years old on average and predominantly female (77%). The path analysis showed that higher scores in caregiver preparedness were associated with higher scores in caregiver confidence. In turn, higher caregiver confidence was associated with higher CC to self-care maintenance and management. Caregiver confidence mediated the association between caregiver preparedness and CC to self-care maintenance and management.

CONCLUSIONS

Caregiver confidence may play a role in CC to self-care. Interventions to improve CC to HF self-care should not only be focused on improving caregiver preparedness but also should consider the role of caregiver confidence.

Self-care in spinal cord injuries inventory (SC-SCII) and self-care self-efficacy scale in spinal cord injuries (SCSES-SCI): development and psychometric properties

STUDY DESIGN

Validation cross-sectional study.

OBJECTIVES

To develop and assess the psychometric properties of two instruments based on the middle-range theory of self-care in chronic illness: the Self-Care in Spinal Cord Injuries Inventory (SC-SCII) and the Self-Care Self-Efficacy Scale in Spinal Cord Injuries (SCSES-SCI).

SETTING

Multicenter study in five spinal units across Italy and Ireland.

METHODS

Instrument development was based on self-care behaviours identified in the scientific literature. Behaviours were grouped into four dimensions during a consensus conference: self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy. Sixty-seven items were subsequently generated based on these dimensions. A multidisciplinary group of 40 experts evaluated content validity. Dimensionality of the final items was tested by confirmatory factor analyses (CFA) with a sample of 318 participants. Internal consistency and test-retest reliability were evaluated for each dimension. Construct validity was assessed using correlations between items and scoring differences amongst participants with more severe conditions and secondary complications.

RESULTS

Content validity of the SC-SCII and SCSES-SCI was satisfactory for thirty-five of the previously generated items, which were further refined. CFA showed comparative fit indexes ranging from 0.94 to 0.97 and root mean square errors of approximation from 0.03 to 0.07. Internal consistency ranged from 0.71 to 0.85, and intraclass correlation coefficients were higher than 0.70. Correlations among dimensions were moderate, and the theoretical hypotheses formulated when designing the instruments were largely confirmed.

CONCLUSIONS

The SC-SCII and the SCSES-SCI represent valid and reliable theoretically-grounded instruments to assess self-care in people with spinal cord injury.