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Learning Objective 1: To describe the influence of self-efficacy in HF self-care among individuals with HF and a comorbid condition.
Learning Objective 2: To discuss the implications for nursing research and clinical practice of improving self-care by patients with multiple comorbid conditions.
Methods: Using qualitative meta-analysis techniques, transcripts from three mixed methods studies investigating HF self-care (n=99) were re-examined to yield themes about self-efficacy in self-care and explore the influence of comorbid conditions on HF self-care. The Charlson Comorbidity Index (α=.89) identified comorbid conditions.
Results: The sample was 74% Caucasian, 66% male, mean age of 59.6 (± 15) years. Most (79%) reported at least 2 chronic conditions. Diabetes was reported by 34%. Narrative accounts revealed that the most challenging skills were adherence to low salt diet, symptom monitoring, and differentiating symptoms of HF from other conditions. Self-efficacy emerged as an important variable that influenced self-care by shaping how individuals: 1) prioritized self-care of one condition over another (“I can tell if my sugar is up… don’t even have to stick myself”) and 2) integrated multiple self-care instructions. Subjects who felt ill-prepared to carry out self-care lacked self-efficacy in HF self-care within the context of another condition. As a result of fragmented self-care instructions (“…diabetic nurse didn’t mention salt”), individuals selected one set of self-care behaviors to engage in, most often those in which they felt most confident (“…the diabetes diet….that I can do…”).
Conclusion: Individuals with multiple chronic conditions are vulnerable to poor self-care related to insufficient skill and poor self-efficacy. Coaching interventions that integrate self-care requirements, focus on improving self-efficacy and develop skill in self-care across multiple chronic conditions are needed.