Influence of Social Support and Negative Emotional Status on Self-care Adherence in Symptomatic Patients with Heart Failure

In-Suk Yang

doi:10.7469/kjan.2016.28.3.302

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Yang: Influence of Social Support and Negative Emotional Status on Self-care Adherence in Symptomatic Patients with Heart Failure

Original Article

Korean J Adult Nurs 2016;28(3):302-313.

Published online: June 2016

DOI: https://doi.org/10.7469/kjan.2016.28.3.302

Influence of Social Support and Negative Emotional Status on Self-care Adherence in Symptomatic Patients with Heart Failure

In-Suk Yang

Department of Nursing, Kyungil University, Gyeongsan, Korea

Corresponding author: Yang, In-Suk Department of Nursing, Kyungil University, 50 Gamasil-gil, Hayang-eup, Gyeongsan 38428, Korea. Tel: +82-53-600-5664, Fax: +82-53-600-5679, E-mail: insookyang@gmail.com

Received 5 April 201616 June 2016 Accepted 20 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The objective of this study was to identify factors related to self-care adherence in symptomatic patients with heart failure (HF).

Methods

Using a cross-sectional design, a convenience sample 209 outpatient clinic patients were recruited at two medical centers. Between October 2011 and August 2012, data were collected using the structured questionnaire. Factors related to self-care adherence were examined using hierarchical multiple regression.

Results

Mean age of participants was 67.71 years and a half of them (53.6%) were female. They showed relatively low self-care adherence with mean scores of 61.88±12.92. Lower self-care adherence was reported in asking for low sodium items, weighing oneself, checking for ankle edema, and exercising for 30 minutes. The overall model significantly explained 23.9% of variance in self-care adherence. Among the predictors, education, New York Heart Association functional classification, and social support were statistically significant in influencing self-care adherence. The variable of negative emotional status such as anxiety and depression were not found to be significant.

Conclusion

These findings demonstrate that social support could help self-care adherence among symptomatic patients with HF. Thus, programs targeting self-care adherence in this population should consider the strategies improving social support.

Keywords: Social support, Anxiety, Depression, Self care, Heart failure

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Table 1.

Differences in Self-Care Maintenance based on Sociodemographic and Clinical Characteristics (N=209)

Characteristics	Categories		n (%) or M±SD	Self-care maintenance
Characteristics	Categories		n (%) or M±SD	M±SD	t or F or r	p (Scheffé)
Age (year)	＜65		69 (33.0)	65.00±13.87	3.19	.043
	65~74		70 (33.5)	60.86±11.73
	≥75		70 (33.5)	59.82±12.68
Gender	Male		97 (46.4)	64.97±12.20	3.30	.001
Gender	Female		112 (53.6)	59.20±12.98
Education completed	No formal education^a		24 (11.5)	53.13±10.84	4.70	.001
	≤Elementary school^b		75 (35.9)	60.60±12.29		(a＜b, c, d, e)
	≤Middle school^c		29 (13.9)	64.48±12.72
	≤High school^d		43 (20.6)	63.60±12.61
	≥College^e		38 (18.2)	65.99±13.45
Spouse	No		100 (47.8)	60.40±12.38	-1.59	.113
Spouse	Yes		109 (52.2)	63.23±13.30
Occupation	Unemployed		146 (69.9)	60.72±12.86	1.99	.048
Occupation	Employed		63 (30.1)	64.56±12.75
Monthly income ($)	＜2,000		125 (59.8)	61.36±12.47	-0.71	.481
Monthly income ($)	≥2,000		84 (40.2)	62.65±13.59
NYHA classification	II^a		126 (60.3)	64.86±11.55	15.11	＜.001
	III^b		61 (29.2)	60.00±13.17		(a＞b, c)
	IV^c		22 (10.5)	50.00±12.30		(b＞c)
Left ventricular ejection fraction (%)	≤50		116 (55.5)	62.26±13.27	0.48	.632
Left ventricular ejection fraction (%)	＞50		93 (44.5)	61.40±12.51
NT pro-BNP (pg/mL)			4,092.10±7,125.53	61.88±12.92	-.04	.526
Etiology	Coronary artery disease		48 (23.0)	61.72±13.03	1.39	.248
	Hypertension		51 (24.4)	60.34±12.01
	Valvular heart disease		28 (13.4)	63.75±11.81
	Cardiomyopathy		60 (28.7)	64.04±13.36
	Other		22 (10.5)	57.50±14.31
Time since diagnosed (month)	≤60		112 (53.6)	61.21±12.78	0.91	.437
	61~120		45 (21.5)	64.17±13.79
	121~180		24 (11.5)	59.48±12.81
	≥181		28 (13.4)	62.95±12.15
Number of hospitalization			1.91±3.59	61.88±12.92	-.04	.109
Number of medication	1~2		34 (16.3)	64.12±16.35	2.45	.089
	3~4		112 (53.6)	62.83±12.41
	≥5		63 (30.1)	58.97±11.35
Comorbidity	MI	Yes	26 (12.4)	61.15±14.08	-0.31	.761
	MI	No	183 (87.6)	61.98±12.78
	Cerebrovascular disease	Yes	36 (17.2)	59.93±13.41	-0.99	.321
	Cerebrovascular disease	No	173 (82.8)	62.28±12.82	-0.99	.321
	Diabetes mellitus	Yes	64 (30.6)	62.23±11.67	0.26	.796
	Diabetes mellitus	No	145 (69.4)	61.72±13.47
	Moderate-severe renal disease	Yes	12 (5.7)	65.42±15.03	0.98	.330
	Moderate-severe renal disease	No	197 (94.3)	61.66±12.79
	Ulcerative disease	Yes	20 (9.6)	56.13±14.59	-1.88	.074
	Ulcerative disease	No	189 (90.4)	62.49±12.62

NYHA=New York Heart Association; MI=Myocardial Infarction; NT pro-BNP=N-terminal prohormone of Brain Natriuretic Peptide; Multiple responses.

Table 2.

Social Support, Negative Emotional Status, and Self-Care Maintenance (N=209)

Variables	Categories	n (%)	Actual range	M±SD
Social support			1~5	2.67±1.15
Directive guidance			1~5	2.60±1.25
Emotional support			1~5	2.84±1.27
Tangible support			1~5	2.63±1.08
Social interaction			1~5	2.76±1.24
Negative emotional status
Anxiety	0~7	138 (66.0)	0~21	6.09±4.68
	8~10	31 (14.8)
	11~21	40 (19.1)
Depression	0~7	105 (50.2)	0~21	8.00±4.76
	8~10	48 (23.0)
	11~21	56 (26.8)
Self-care maintenance	＜70	150 (71.8)	27.50~100	61.88±12.92
Self-care maintenance	≥70	59 (28.2)

Table 3.

Descriptive Statistics for Individual Items of the Self-care Maintenance Scale (N=209)

Items	Never or rarely	Sometimes	Frequently	Always or daily	M±SD
Items	n (%)	n (%)	n (%)	n (%)	M±SD
Weigh oneself	68 (32.5)	80 (38.3)	47 (22.5)	14 (6.7)	2.03±0.91
Check ankles for swelling	73 (34.9)	71 (34.0)	43 (20.6)	22 (10.5)	2.07±0.99
Prevent disease (e.g., flu shot, avoid ill people)	28 (13.4)	53 (25.4)	76 (36.4)	52 (24.9)	2.73±0.98
Do some physical activity	40 (19.1)	48 (23.0)	51 (24.4)	70 (33.5)	2.72±1.12
Keep doctor or nurse appointments	3 (1.4)	12 (5.7)	61 (29.2)	133 (63.6)	3.55±0.67
Eat a low sodium diet	67 (32.1)	55 (26.3)	48 (23.0)	39 (18.7)	2.28±1.10
Exercise for 30 minutes	90 (43.1)	53 (25.4)	26 (12.4)	40 (19.1)	2.08±1.15
Forget to take one of medications	9 (4.3)	8 (3.8)	34 (16.3)	158 (75.6)	3.63±0.76
Ask for low sodium items when eating out or visiting others	135 (64.6)	47 (22.5)	15 (7.2)	12 (5.7)	1.54±0.86
Use a pill box or reminders to remember taking medications	98 (46.9)	33 (15.8)	33 (15.8)	45 (21.5)	2.12±1.22

Table 4.

Bivariate Associations among Key Variables (N=209)

Variables	Categories	Negative emotional status		Self-care maintenance
		Anxiety	Depression	Self-care maintenance
		r (p)	r (p)	r (p)
Social support		-.41 (＜.001)	-.42 (＜.001)	.31 (＜.001)
Negative emotional status	Anxiety	-	.73 (＜.001)	-.31 (＜.001)
Negative emotional status	Depression	-	-	-.33 (＜.001)

Table 5.

Hierarchical Regression Model of Predicting Self-care Maintenance in Patients with Symptomatic Heart Failure (N=209)

Step	Variables	Categories	β	t	p
Step 1	Age	65~74	-.10	-1.26	.208
	Age	≥75	-.08	-0.96	.338
	Gender	Male	.05	0.63	.532
	Education completed	Elementary school	.25	2.40	.017
		Middle school	.24	2.46	.015
		High school	.22	2.09	.038
		≥College	.25	2.25	.026
	Occupation	Employed	.01	0.17	.866
	NYHA	Class III	-.13	-1.92	.056
	NYHA	Class IV	-.32	-4.74	＜.001
			Adjusted R²=.16, F=4.73, p＜.001
Step 2	Age	65~74	-.11	-1.40	.163
	Age	≥75	-.13	-1.51	.133
	Gender	Male	.05	0.57	.571
	Education completed	Elementary school	.26	2.54	.012
		Middle school	.23	2.47	.014
		High school	.19	1.83	.069
		≥College	.22	2.03	.043
	Occupation	Employed	.05	0.77	.441
	NYHA	Class III	-.12	-1.78	.077
	NYHA	Class IV	-.29	-4.31	＜.001
	Social support		.25	3.64	＜.001
	Anxiety		-.08	-0.85	.398
	Depression		-.04	-0.37	.709
			Adjusted R²=.24, F=6.03, p＜.001

R² Change=.09 (p＜.001); NYHA=New York Heart Association; Reference (Age:＜65, Gender: Female, Education: No formal education, Occupation: Unemployed, NYHA: Class II).

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