Antecedents and Outcomes of Self-Care in Adults with Congenital Heart Disease 公开
McCabe, Nancy (2015)
Published
Abstract
Background : Adults with congenital heart defects (ACHD) face long-term complications related to prior surgery, abnormal anatomy, and acquired cardiovascular conditions. Although self-care is an important part of chronic illness management, few studies have explored ACHD self-care.
Purpose : The purpose of this study was to describe the antecedents and outcomes of self-care in the ACHD population, guided by the Family and Self-Care Framework.
Methods : Persons with moderate or severe ACHD were recruited from a single ACHD center. Self-care (maintenance, monitoring and management behaviors), antecedents (individual, clinical, knowledge, behavioral, and family-related factors), and outcomes (functional capacity, symptom burden, and 3-month health resource use) were collected via self-report, chart review, and a six-minute walk test (6MWT). Bivariate correlations, linear and logistic regression were used for analyses.
Results: A total of 132 persons were included (mean age 36 ± 11 years, 55% female, 81% Caucasian, 54% severe ACHD). Only 44.7%, 27.3%, and 23.3% of participants performed adequate self-care maintenance, monitoring and management, respectively. In regression analysis, higher self-efficacy, higher education, male gender, higher perceived family support, and more comorbidities explained 25% of the variance in self-care maintenance (R2=.248, F(5, 123)=9.44, p<.001). Older age, higher depressive symptoms, higher self-efficacy, and higher NYHA Class explained 23% of the variance in self-care monitoring (R2=.232, F(2, 124)=10.66, p<.001). Higher self-efficacy and higher NYHA Class explained 9% of the variance in self-care management (R2=.094, F(2, 80)=5.27, p=.007). Participants walked an average of 1365 ± 275 feet on the 6MWT and experienced 7.4 ± 4.8 symptoms. A total of 101 (80.8%) participants experienced 310 healthcare encounters (275 office visits, 21 hospitalizations, 20 ED visits). Self-care management (beta=-44.20, p=.001) and monitoring (beta=-14.59, p=.03) were independently associated with functional capacity; self-care maintenance and monitoring were independently associated with symptom burden (beta=-.39, p<.001; beta=1.52, p<.001); higher self-care monitoring was an independent predictor of >1 health encounter (OR=1.21, 95% CI [1.09, 1.35], p<.001).
Conclusions: Suboptimal self-care is common among persons with ACHD, and is associated with worse functional health. Modifiable factors of self-efficacy and perceived family support may be important targets of future self-care interventions to improve health outcomes in the ACHD population.
Table of Contents
Table of Contents
Chapter 1 - Introduction ……….……………………………………………….....…… 1
Figure 1.1 Family and Self-Care Framework…...…..………..….…...…....5
Figure 1.2 Family and Self-Care Framework for ACHD.…..…..………….9
Figure 1.3 Social Relations and Health…….…………….…………......……..19
Table 1.1 Sample Size Projections……………...………………….......……….26
Table 1.2 Self-Reported Instruments.…………..………………......………….31
Table 1.3 Targeted/Planned Enrollment…………….…………......………….39
Chapter 2 - Self-Care in Adults with Congenital Heart Disease: A Literature
Synthesis………………………………..………………………………………….........…..61
Figure 2.1 Family and Self-Care Framework………………..…..……….....83
Figure 2.2 ACHD Self-Care Search Terms…………………..…….....……….84
Table 2.1 Best Evidence Synthesis Rating System…..….………..……...85
Table 2.2 Antecedents of Self-Care in ACHD…………………....….....……86
Table 2.3 Gaps in the Literature for ACHD Self-Care………….…...…….87
Chapter 3 - Antecedents of Self-Care in Adults with Congenital Heart
Disease……………………………………………………………………….…..…............102
Figure 3.1 Family and Self-Care Framework for ACHD…………..…….126
Table 3.1 Individual and Clinical Characteristics………………….…..…..127
Table 3.2 Bivariate Relationships Between Self-Care and Antecedent
Factors …………………………………………….…….…............................……128
Table 3.3 Multivariate Regression Analysis……………………......….……129
Figure 3.2 Relationship Between Adequate Level of Self-Care and Self-
Efficacy………………………………………………………..............................…130
Chapter 4 - Relationship Between Self-Care, Functional Health, and Health
Resource Use in Adults with Congenital Heart Defects………………...140
Table 4.1 Inclusion and Exclusion Criteria……………...…………..........156
Table 4.2 Baseline Characteristics……………...……………..……..........…157
Table 4.3 Health Resource Use…………………...……………...........…..….158
Table 4.4 Multivariate Regression Analysis………………….......……..….159
Figure 4.1 Relationship Between Most Burdensome Symptoms and
Self-Care ……………………………..……………………..............................…160
Chapter 5 - Conclusion ……………………………………........……..…………….166
Table 4.1 Inclusion and Exclusion Criteria……………………….........…..184
Appendix A
Emory IRB Approval Letter
Written Informed Consent
HIPAA Authorization
REDCap Database Forms
Permission to Reprint Figure
Table 2.4. Literature Synthesis Supplemental Table
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