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The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure

Young, Lufei PhD, RN, APRN-NP; Kupzyk, Kevin PhD; Barnason, Susan PhD

Journal of Cardiovascular Nursing: July/August 2017 - Volume 32 - Issue 4 - p E1–E8
doi: 10.1097/JCN.0000000000000390
Feature Article/Online Only

Background: Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.

Objective: The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.

Methods: A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.

Results: Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; β = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support.

Conclusions: Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients’ SM confidence.

Lufei Young, PhD, RN, APRN-NP Associate Professor, College of Nursing, Augusta University, Georgia.

Kevin Kupzyk, PhD Assistant Professor, College of Nursing, University of Nebraska Medical Center, Omaha.

Susan Barnason, PhD Assistant Professor, College of Nursing, University of Nebraska Medical Center, Lincoln.

This study was supported by the National Institute of Nursing Research of the National Institutes of Health under award number 1R15NR 13769-01A1. The sponsor had no role in conducting the study, preparing data analysis, or generating and disseminating the study results. Dr Lufei Young is the recipient of the funding provided by the National Institute of Nursing Research of the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Correspondence Lufei Young, PhD, RN, APRN-NP, College of Nursing, Augusta University, 987 St Sebastian Way, Augusta, GA 30912 (luyoung@augusta.edu).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved