A Mixed-Methods Study of Social Determinants and Self-care in Adults With Heart Failure

Abstract

Background The burden of heart failure (HF) is unequally distributed among population groups. Few study authors have described social determinants of health (SDoH) enabling/impeding self-care. Aim The aim of this study was to explore the relationship between SDoH and self-care in patients with HF. Methods Using a convergent mixed-methods design, we assessed SDoH and self-care in 104 patients with HF using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and the Self-Care of HF Index v7.2 with self-care maintenance, symptom perception, and self-care management scales. Multiple regression was used to assess the relationship between SDoH and self-care. One-on-one in-depth interviews were conducted in patients with poor (standardized score ≤ 60, n = 17) or excellent (standardized score ≥ 80, n = 20) self-care maintenance. Quantitative and qualitative results were integrated. Results Participants were predominantly male (57.7%), with a mean age of 62.4 ± 11.6 years, with health insurance (91.4%) and some college education (62%). Half were White (50%), many were married (43%), and most reported adequate income (53%). The money and resources core domain of PRAPARE significantly predicted self-care maintenance (P = .019), and symptom perception (P = .049) trended significantly after adjusting for other PRAPARE core domains (personal characteristics, family and home, and social and emotional health) and comorbidity. Participants discussed social connectedness, health insurance coverage, individual upbringing, and personal experiences as facilitators of self-care behavior. Conclusion Several SDoH influence HF self-care. Patient-specific interventions that address the broader effects of these factors may promote self-care in patients with HF.

Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy

“…27,28 The patients also discussed the importance of both family and peer social support; similar to other research, they indicated how critical family support was but how social support networks were often lacking. 27,28 The patients and caregiver felt that virtual support groups or recordings of other patients should be leveraged to build comradery, provide an opportunity to ask questions, and learn about others' experiences with HF. The patients and caregiver also spent much of the conversation discussing the challenges in managing dietary restrictions, both for HF but also in tandem with those of other chronic conditions.…”

“…The patients also discussed how important it was for them to regain their independence and quality of life, but as a motivator to GDMT uptake. Other research has noted that patients with HF and family members often struggle with poor quality of life and that patients have a difficult time with the loss of independence and need to rely on others 27,28 . The patients also discussed the importance of both family and peer social support; similar to other research, they indicated how critical family support was but how social support networks were often lacking 27,28 .…”

“…Other research has noted that patients with HF and family members often struggle with poor quality of life and that patients have a difficult time with the loss of independence and need to rely on others 27,28 . The patients also discussed the importance of both family and peer social support; similar to other research, they indicated how critical family support was but how social support networks were often lacking 27,28 . The patients and caregiver felt that virtual support groups or recordings of other patients should be leveraged to build comradery, provide an opportunity to ask questions, and learn about others' experiences with HF.…”

“…Previous research has found that lower socioeconomic status (education, employment, insurance type, transportation, and federal poverty level) is associated with worse HF self-care. 27 In this study, the clinicians mentioned that balancing medication adverse effects and quality of life was often a challenge for patients and a barrier to GDMT optimization. The patients also discussed how important it was for them to regain their independence and quality of life, but as a motivator to GDMT uptake.…”

“…Interestingly, the patients and caregiver did not cite this as a challenge; however, the participants were well educated, employed, and had health insurance. Previous research has found that lower socioeconomic status (education, employment, insurance type, transportation, and federal poverty level) is associated with worse HF self-care 27 …”