Objective: Self-management decision making places significant cognitive demands on individuals with heart failure (HF), even as the disease increasingly impairs their cognitive abilities. Before theoretically valid decision supports can be developed to assist these individuals in their self-management decisions, a better understanding of underlying decision characteristics is needed. The purpose of this preliminary study was to describe antecedent sources of self-management decision influences for individuals (n=38) with varying levels of HF (NYHA class II – IV).
Design: Non-experimental, correlational
Sample and Setting: A non-random sample of 38 individuals (50% male, mean age 60.7 (+13.8)) attending an outpatient HF clinic at a urban, tertiary, academic medical center from May, 1999 to April, 2000.
Concepts Studied: Internal and external influences on self-management decision making.
Methods: The Heart Failure Decision Influence Inventory (HFDII) was developed for this study. After an extensive review of the decision making, adherence, and health belief literature, items were developed specific to HF self-management and grouped under 5 broad categories: Therapeutic Belief, Task Difficulty, Symptom Influence, Information Sources, and Personal Beliefs and Values. The tool uses a likert-type format (1=little influence on my self-management decisions, 4=Great influence on my self-management decisions). Content validity was strong (CVI=.89). After deleting items with negative correlations and those whose item-to-scale correlations were less than .2, Cronbach’s alphas were acceptable: Therapeutic Belief (.823, 7 items), Task Difficulty (.722, 7 items), Symptom Influence (.751, 17 items), Information Sources (.730, 7 items), and Personal Beliefs and Values (.829, 18 items). Scores were calculated by summing item responses and dividing by the number of items in the scale. Higher scores represent greater influence on self-management decisions. Scales are not summative.
Findings: Therapeutic value was the most influential source of self-management decision making for these patients, followed by personal beliefs and values, and information sources across all NYHA classes. Symptom influence was least influential for persons in Class II, while task difficulty was least influential for those in Class III and IV. Moderate and significant associations were noted between information sources and personal beliefs and values, and information sources and symptom influence. Weak and significant associations were noted between information sources and therapeutic value, and information sources and task difficulty. As the disease progressed, a trend toward fewer decision influences, especially in the task difficulty scale, was noted.
Conclusions: Self-management decision influences vary across the trajectory of HF, with fewer influences as the disease progresses. Patients’ decisions are most strongly influenced by the belief that self-management interventions such as taking medications, weighing self, avoiding salt, are valuable in helping them control their disease.
Implications: Understanding individuals’ decision influences may provide better insight into their self-management behavior, and could be helpful in guiding the development of decision support interventions to assist them in their self-management decision making.
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