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Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure

Wierenga, Kelly L. PhD, RN

doi: 10.1097/JCN.0000000000000403
ARTICLES: Psychological Health

Background: African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors.

Objective: The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population.

Methods: African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events.

Results: Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence.

Conclusions: Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence.

Kelly L. Wierenga, PhD, RN Postdoctoral Fellow, Case Western Reserve University, Cleveland, Ohio.

The author has no funding or conflicts of interest to disclose.

Correspondence Kelly L. Wierenga, PhD, RN, Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120 Cornell Rd, Cleveland, OH 44106 (

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