All ETDs from UAB

Advisory Committee Chair

Robin G Lanzi

Advisory Committee Members

Kristi C Guest

Young-Il Kim

Dorothy Pekmezi

Cynthia J Petri

Document Type

Dissertation

Date of Award

2013

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Self-care is a major component of heart failure management. Excess weight is a disease that may negatively affect a patient's ability to effectively practice self-care. The project aimed to assess 1) the relationship between weight status and heart failure self-care behaviors and 2) the modification of the relationship between social support and heart failure self-care by weight status. This cross sectional study utilized baseline data from a cohort of African-American and Caucasian participants diagnosed with heart failure. The heart failure cohort was formed from three larger studies (n=690) designed to assess the relationships among social support, self-care behaviors and hospital use in a population of participants with heart failure. Body mass index was used to measure weight status. Total heart failure self-care was assessed as well as the components of total self-care maintenance and self-care management. Chi-Square analyses and ANOVA tests were performed to determine differences in proportions and means of weight status and scale scores for total self-care, self-care maintenance and self-care management. The primary outcomes in the study are weight status for Aim 1 and total self-care, self-care maintenance and self-care management for Aim 2. The unadjusted and adjusted association of considered key predictors with the primary outcomes were estimated by performing cumulative logistic regression models. Sample demographic variables were included in the models as adjustors. An interaction term of social support and BMI was tested at p <0.1 to determine if stratification of adjusted models for total self-care, maintenance and management were warranted. Female gender, African-American race, and low self-care knowledge differed according to weight status. More numerous comorbidities, higher heart failure knowledge and attending a regional referral center were associated with an increased odds of higher weight. Increased heart failure self-care efficacy, was associated with a decrease in the odds of inadequate total self-care, maintenance and management. High heart failure knowledge was associated with a decrease in odds of inadequate total self-care and management. Compared to normal and overweight, being obese was associated with increase in the odds of inadequate self-care maintenance. The thresh hold for the interaction term of BMI and social support was not met. High levels of self-efficacy and heart failure knowledge are warranted when working to improve uptake of self-care among heart failure patients. These findings suggest that additional studies into the direct association of weight status on self-care are needed. From a public health perspective, there is a need for the development of patient-tailored, educational interventions aimed at improving self-care practice.

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