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

Abstract

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.

Effectiveness of a nurse‐led, face‐to‐face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions

“…The observed improvement in activation among participants who received the intervention (IG) is consistent with previous reports (Roberts et al, 2016;Wolever & Dreusicke, 2016;Young, Kupzyk, & Barnason, 2017) and supports the idea that HC is a useful, nondisease-specific method for improving activation in people with chronic conditions, even in the presence of multimorbidity. As to why the improvement in activation was not maintained across follow-up, | 465 the intervention may have been too short to allow for consolidation of change, insofar as those HC interventions that have been found to be effective in follow-up assessments were longer than ours both in number of sessions and overall length of the program (Park et al, 2017;Sharma et al, 2016).…”

Patient activation in adults with chronic conditions: A systematic review

“…Patient activation in supporting self-management strategies (Aung et al, 2016) is a self-reported measure of strength of self-management (Shively et al, 2013). Given the complex relationships among patient activation and self-management, the PAM measure has been shown effective as the method in quantifying the patient’s ability to conduct self-management (Young et al, 2017). A challenge in using the PAM-13 is the licensing fee for conducting studies in small centers, with licensing fees available at https://www.insigniahealth.com/products/pam-survey (Shively et al, 2013; Titova et al, 2017; Turner et al, 2014).…”

The Situation-Specific Theory of Heart Failure Self-care

“…When studies on patient activation were synthesized in a systematic review of randomized controlled trials, interventions that improved patient activation significantly improved self-care in a variety of other chronic conditions 99 and for a variety of intermediate outcomes such as depression, anxiety, and self-efficacy 100 . Investigators studying the association between patient activation and HF self-care demonstrated that patients with HF who are more “active” engage in better self-care behaviors 101 regardless of their HF knowledge and health literacy 102 and that patient activation mediates the relationship between self-efficacy and self-care when HF self-care knowledge is low 103 …”