The influence of dyadic congruence and satisfaction with dyadic type on patient self-care in heart failure

Abstract

Background: Chronic illness management is increasingly carried out at home by individuals and their informal caregivers (dyads). Although synergistic in concept, the nuances of dyadic congruence in caring for patients with heart failure are largely unexamined. Aims: The purpose of this study was to examine the role of dyadic-type congruence on patient self-care (maintenance, symptom perception, and management) while controlling for actor and partner effects. Methods: This secondary data analysis of 277 dyads consisted of a series of multilevel models to examine the impact of dyadic congruence on a patient’s self-care maintenance, symptom perception, and self-care management. Patient-level and caregiver-level data were input into each model simultaneously to account differential appraisals of factors related to the dyad. Results: Bivariate analyses yielded dyad congruence which was associated with better patient self-care maintenance, symptom perception and management. However, after multilevel models were constructed, dyad congruence was found to be a significant predictor of patient’s symptom perception scores, but not self-care maintenance or management scores. Caregiver’s satisfaction with the dyad was differentially and significantly associated with self-care – it was inversely associated with patient self-care maintenance and positively associated with patient self-care management. Conclusion: This is the first study, to our knowledge, reporting that congruence in heart failure dyads is associated with better patient symptom perception and this advances our prior hypothesis that dyad typologies could be used to predict patient self-care performance. Since symptom perception is the key to preventing heart failure exacerbation, screening heart failure patient and caregiver dyads for congruence is important in clinical settings.

Heart Failure Care: Testing Dyadic Dynamics Using the Actor-Partner Interdependence Model (APIM)—A Scoping Review

“…There also is evidence that a caregiver is more likely to contribute to HF self-care management if the caregiver is not the patient’s spouse [ 46 ]. Involvement in self-care also is associated with the emotional state of the caregiver, the quality of the relationship between the HF patient and the caregiver [ 47 , 52 , 54 ], and the caregiver’s knowledge of self-care [ 47 ]. Patients are more adherent to recommendations when they have a decreased physical quality of life [ 48 ].…”

“…The complex interrelationships between patient and caregiver factors revealed by APIM research are depicted in Figure A2 ( Appendix A ). Figure A2 shows, for instance, that a patient’s self-care outcome (i.e., maintenance, management, symptom perception, or confidence) is significantly related to relationship quality [ 16 , 46 ], dyad congruence [ 54 ], as well as caregivers’ depressive symptoms and anxiety [ 47 ], mental quality of life [ 16 ], satisfaction with dyadic type [ 54 ], and patient mutuality [ 45 , 52 ]. Figure A3 ( Appendix A ), in turn, shows results of APIM research on caregiver quality of life and emotional aspects of dealing with HF patients.…”

“…(Bugajski et al, 2020) [54] Italy; 277 dyad; (patient-spousal and non-spousal caregiver); 55% male patients; M age = 75.5 (patient) and M age = 52.8 (caregiver) Self-care of HF Index (SCHFI) and Caregiver Contribution to Self-care of HF Index (CC-SCHFI);…”

Characteristics of dyadic care types among patients living with multiple chronic conditions and their informal caregivers

“…In the patient-oriented dyadic care type I, patients engage in their own self-care without any support from their caregivers; in the caregiver-oriented type II, caregivers manage patients' care, with the patient assuming a less active role; in the collaborative-oriented type III, both members of the dyad are engaged in patient self-care, sharing the decisions and actions related to self-care or negotiating different spheres of responsibilities about patient self-care; finally, in the incongruent type IV, patients and caregivers disagree on who is responsible for patient self-care (Buck et al, 2019). Research shows that incongruent types perform lower on self-care behaviours compared with the other types in which there is agreement about the primary responsibility for patient self-care (Bugajski et al, 2021). Despite this earlier work in HF and COPD (Ivziku et al, 2018)…”

“Help me to take care”: Professional expectations about using an application in heart failure

“…In HF, these concepts positively influence treatment adherence, change in lifestyle, monitoring and recognition, and response to symptoms. [15] Still, they promote support in the face of the occurrence of psychological disorders. [16] Contrary to the concern (Fuersorge), care for occupation (Besorgen) is due to obligation, mediated only by technique; impersonality prevails, that is, there is no perception of the other as an extension of one's presence (Dasein).…”