“Can Do….” Self-Efficacy in Self-Care Among Individuals with Heart Failure Plus Multiple Comorbid Conditions

Monday, July 11, 2011

Victoria Vaughan Dickson, PhD, RN, CRNP1
Harleah G. Buck, PhD, RN, CHPN2
Barbara Riegel, RN, CS, FAAN2
(1)College of Nursing, New York University, New York, NY
(2)School of Nursing, University of Pennsylvania, Philadelphia, PA

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.

Purpose: Most heart failure (HF) patients report comorbid conditions. HF self-care requires medication and diet adherence, daily weight monitoring, and response to symptoms when they occur. Multiple comorbid conditions may lower self-efficacy in self-care and interfere with one's abiity to manage HF. The purpose of this qualitative meta-analysis was to explore the influence of self-efficacy in HF self-care among individuals with HF plus another condition. 

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.