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Multiple Comorbid Conditions Challenge Heart Failure Self-Care by Decreasing Self-Efficacy
Nursing Research
  • Victoria Vaughan Dickson, New York University
  • Harleah G. Buck, Pennsylvania State University
  • Barbara Riegel, University of Pennsylvania
Document Type
Publication Date
  • comorbidity,
  • chronicity,
  • heart failure,
  • mixed methods,
  • self-care,
  • self-efficacy
Digital Object Identifier (DOI)

Background: Most heart failure patients have multiple comorbidities.

Objective: This study aims to test the moderating effect of comorbidity on the relationship between self-efficacy and self-care in adults with heart failure.

Methods: Secondary analysis of four mixed methods studies (n = 114) was done. Self-care and self-efficacy were measured using the Self-Care of Heart Failure Index. Comorbidity was measured with the Charlson Comorbidity Index. Parametric statistics were used to examine the relationships among self-efficacy, self-care, and the moderating influence of comorbidity. Qualitative data yielded themes about self-efficacy in self-care and explained the influence of comorbidity on self-care.

Results: Most (79%) reported two or more comorbidities. There was a significant relationship between self-care and the number of comorbidities (r = −.25; p = .03). There were significant differences in self-care by comorbidity level (self-care maintenance, F[1, 112], 5.96, p = .019, and self-care management, F[1, 72], 4.66, p = .034). Using moderator analysis of the effect of comorbidity on self-efficacy and self-care, a significant effect was found only in self-care maintenance among those who had moderate levels of comorbidity (b = .620, p = .022, Fchange df[6,48], 5.61, p = .022). In the qualitative data, self-efficacy emerged as an important variable influencing self-care by shaping how individuals prioritized and integrated multiple and often competing self-care instructions.

Discussion: Comorbidity influences the relationship between self-efficacy and self-care maintenance, but only when levels of comorbidity are moderately high. Methods of improving self-efficacy may improve self-care in those with multiple comorbidities.

Citation / Publisher Attribution

Nursing Research, v. 62, issue 1, p. 2-9

Citation Information
Victoria Vaughan Dickson, Harleah G. Buck and Barbara Riegel. "Multiple Comorbid Conditions Challenge Heart Failure Self-Care by Decreasing Self-Efficacy" Nursing Research Vol. 62 Iss. 1 (2013) p. 2 - 9
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