Structural equation model testing the situation-specific theory of heart failure self-care

Abstract

Aim: To test the situation-specific theory of heart failure self-care with structural equation modelling.

Background: Several authors have proposed theories on heart failure self-care, but only the situation-specific theory of heart failure self-care by Riegel and Dickson is focused on the process that patients use to perform self-care. This theory has never been tested with structural equation modelling.

Design: A secondary analysis of data from a cross-sectional study.

Methods: Patients with heart failure were recruited in 21 cardiovascular centres across Italy during 2011. Data were collected with a sociodemographic questionnaire, chart abstraction for clinical data and the Self-Care of Heart Failure Index v.6.2.

Results: A sample of 417 participants was enrolled in the study (59% males, mean age 72 years). The following propositions were tested and supported: Symptom monitoring correlates with treatment adherence; symptom monitoring and treatment adherence have a direct, positive relationship with symptom recognition and evaluation that in turn have a direct, positive relationship with treatment implementation; treatment implementation has a direct, positive relationship with treatment evaluation. In addition, the following three relationships were found: Symptom monitoring has a direct, positive relationship with treatment implementation; symptom recognition and evaluation have direct, positive relationships with treatment evaluation and symptom monitoring correlates with treatment evaluation. [Correction added on 9th April 2013, after first online publication: '…symptom monitoring correlates with treatment implementation.' has been corrected to read '…symptom monitoring correlates with treatment evaluation.']

Conclusion: The data support the situation-specific theory of heart failure self-care with the addition of three new relationships that emerged from the analysis. Results of this study lend further support to the use of the situation-specific theory of heart failure self-care in research and practice.

Keywords: heart failure; nursing; self-care; structural equation modelling; symptom monitoring; symptom recognition and evaluation; theory testing; treatment adherence; treatment implementation.