Ethnicity Moderates the Relationship Between Perceived Social Support and Self-Care Confidence in Heart Failure Patients

Objectives: The purpose of this secondary data analysis was to examine the relationship between perceived social support (PSS) and self-care confidence (SCC) in a sample of patients with heart failure (HF). We hypothesized that the relationship between PSS and SCC is moderated by ethnicity.

Background: African Americans are at the highest risk of developing HF compared to other ethnicities and are hospitalized seven to eight times more often than Caucasians. Poor overall self-care, low SCC and lower levels of PSS are factors related to increased risk for hospitalizations in HF. Previous investigators reported that SCC is a moderator of self-care ability in people with HF, however, little is known regarding the factors that may impact SCC in people with HF.

Methods: Patients with HF completed measures of PSS (Multidimensional Scale of Perceived Social Support) and SCC (Self-Care of Heart Failure Index; Self-Care Confidence Subscale). Patients included in this analyses were either African American or Caucasian. Moderation analysis was conducted using hierarchal linear regression. In the first step, PSS and ethnicity were entered separately as predictors of SCC. In the second step, the interaction term PSS*ethnicity was entered as a predictor. The interaction term was evaluated for a significant increase in R², which indicates presence of moderation.

± 11.5, 68% were male, and 54.7% were New York Heart Association class I or II. Results from moderation analysis yielded a significant interaction of PSS and ethnicity. In African American patients, there is a non-significant relationship between perceived social support and self-care confidence, b = -0.776, 95% CI [-0.049, 0.060], t = 0.212, p = 0.832. In Caucasian patients, there is a significant positive relationship between perceived social support and self-care confidence b = -0.224, 95% CI [0.046, 0.094], t = 5.65, p <.001.

Conclusions: Ethnicity may play an important role in PSS and SCC in patients with HF. Our results show there was no change in self-care confidence scores as levels of perceived social support increased in African American patients. Conversely, Caucasian patients demonstrated higher self-care confidence scores as level of perceived social support increase. Further research is needed to develop and test interventions that are tailored to the ethnicity and levels of social support in patients with HF.