How Do Knowledge and Cognition Affect Heart Failure Self-Care?

Wednesday, 15 July 2009: 11:25 AM

Victoria Vaughan Dickson, PhD, RN, CRNP1
Christopher S. Lee, MSN, RN, CCRN2
Barbara Riegel, DNSc, RN, CS, FAAN2
1College of Nursing, New York University, New York, NY
2School of Nursing, University of Pennsylvania, Philadelphia, PA

Learning Objective 1: discuss the relationship of knowledge and cognition with heart failure self-care.

Learning Objective 2: discuss how the findings from this study inform the development of future interventions to improve heart failure self care.

Background: Lack of knowledge is assumed to be responsible for poor self-care. Yet, despite extensive patient education, few heart failure (HF) patients  master self-care, defined as an active, cognitive process in which persons engage for the purpose of maintaining health and managing their illness. About half of HF patients have cognitive impairments, which may explain why patient education is often ineffective.
Purpose: To explore knowledge about HF self-care and how knowledge and cognition contribute to self-care.
Methods: In this mixed methods study, 41 adults with HF (68.3% Caucasian, mean age 49.17± 10.51 years) were recruited from two outpatient clinics. Standardized instruments measured self-care (Self-care of Heart Failure Index (SCHFI), knowledge (Dutch Heart Failure Knowledge scale (DHFK), and cognition. A semi-structured interview guide was used to elicit in-depth accounts of self-care and knowledge. Constant comparative analysis was used to integrate qualitative and quantitative results. Hierarchical regression modeling was used to test the hypothesis that cognition, not knowledge, predicted self-care.
Results: The overarching theme that emerged from qualitative data was that lack of skill, not lack of knowledge, drives poor self-care behavior. Self-care was adequate overall (≥70 standardized score; SCHFI maintenance 71.54±14.25; management 71.28±18.20) as was knowledge (DHFK 12.5±1.61). Significant correlations were found between knowledge and cognition (p=.01). Poorer cognition was a significant determinant of self-care, explaining 19.2% of variance in self-care maintenance and 15.2% for self-care management. However, in the qualitative data, those with impaired cognition had poor self-care, (e.g., missed medication, diet lapses, inability to manage symptoms).
Conclusion: Although knowledge was adequate, self-care was inconsistent suggesting that lack of skill has more influence on self-care than knowledge. Subtle cognitive impairments may be responsible for inability to acquire the skill needed to practice self-care. Interventions are needed that foster HF self-care skill, especially among those with cognitive decline.