Despite the high prevalence of depression in HF, little is known about how depression affects symptom perception processes of monitoring, detection, and evaluation. If depression impairs symptom perception, it may delay care-seeking. Aim: To explore how depression influences HF symptom perception. Methods: We enrolled a purposive sample of patients with an unplanned HF hospitalization in this convergent mixed-methods study. Semi-structured in-person interviews were used to explore how patients monitored, detected, and evaluated symptoms prior to hospitalization. HF symptom monitoring, physical symptom presence/severity, and symptom evaluation were measured using the Self-care HF Index, the HF Somatic Perception Scale, and the Illness Perception Scale, respectively. Depression was measured using the Patient Health Questionnaire (PHQ8); score≥10 indicates moderate/severe depression. Qualitative data were analyzed using content analysis to yield categories of symptom type, detection time, and barriers/facilitators for symptom monitoring, detection, and evaluation. To integrate the data, qualitative data were quantified by assigning binary values (e.g. immediacy of symptom detection). Pearson’s correlation and Chi 2 were used to analyze associations. Results: A sample of 40 patients (age 62±13 years, 50% female, 55% White, median HF duration 6 years, 75% NYHA III-IV, 58% PHQ8≥10) was enrolled. There was no significant association between depression and HF symptom monitoring, but moderate/severe depression was described as a barrier to symptom monitoring ("When I get into my depression days, I won't get on the scale, or I just won't do anything."). Depressed patients appeared to detect symptoms more rapidly (p=0.051). More depressed patients reported greater physical symptom severity (r=0.44, p=0.005), but the number of symptoms was not associated with depression. More depressed patients had stronger belief in negative consequences of HF (r=0.46, p=0.003), more negative emotional responses to HF (r=0.60, p<0.001), and less perceived control over HF (r= -0.35, p=0.028). Conclusion: Depressed patients may have difficulties in symptom monitoring, but not in symptom detection. Depression negatively influences symptom evaluation.
Background: Self-care is essential in people with chronic heart failure (HF). The process of self-care was refined in the revised situation specific theory of HF self-care, so we updated the instrument measuring self-care to match the updated theory. The aim of this study was to test the psychometric properties of the revised 29-item Self-Care of Heart Failure Index (SCHFI). Methods: A cross-sectional design was used in the primary psychometric analysis using data collected at 5 sites in the United States. A longitudinal design was used at the site collecting test-retest data. We tested SCHFI validity with confirmatory factor analysis and predictive validity in relation to health-related quality of life. We tested SCHFI reliability with Cronbach α, global reliability index, and test-retest reliability. Results: Participants included 631 adults with HF (mean age, 65 ± 14.3 years; 63% male). A series of confirmatory factor analyses supported the factorial structure of the SCHFI with 3 scales: Self-Care Maintenance (with consulting behavior and dietary behavior dimensions), Symptom Perception (with monitoring behavior and symptom recognition dimensions), and Self-Care Management (with recommended behavior and problem-solving behavior dimensions). Reliability estimates were 0.70 or greater for all scales. Predictive validity was supportive with significant correlations between SCHFI scores and health-related quality-of-life scores. Conclusions: Our analysis supports validity and reliability of the SCHFI v7.2. It is freely available to users on the website: www.self-care-measures.com.
The aim was to develop and psychometrically test the self-care of chronic illness Inventory, a generic measure of self-care.Existing measures of self-care are disease-specific or behaviour-specific; no generic measure of self-care exists.Cross-sectional survey.We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management. Each of the three scales is scored separately and standardized 0-100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing.The Self-Care Maintenance scale (eight items, two dimensions: illness-related and health-promoting behaviour) fit well when tested with a two-factor confirmatory model. The Self-Care Monitoring scale (five items, single factor) fitted well. The Self-Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two-factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model.The self-care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.
AIM The aim was to develop and psychometrically test the self-care of chronic illness Inventory, a generic measure of self-care. BACKGROUND Existing measures of self-care are disease-specific or behaviour-specific; no generic measure of self-care exists. DESIGN Cross-sectional survey. METHODS We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management. Each of the three scales is scored separately and standardized 0-100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing. RESULTS The Self-Care Maintenance scale (eight items, two dimensions: illness-related and health-promoting behaviour) fit well when tested with a two-factor confirmatory model. The Self-Care Monitoring scale (five items, single factor) fitted well. The Self-Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two-factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. CONCLUSION The self-care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.
Heart failure (HF) patients need to perceive symptoms quickly, label them correctly, and manage them well if they want to avoid hospitalization. Little is known about why some are better at this th...
Perceiving symptoms is needed before one can respond to symptoms, but little is known about the difficulties experienced by patients with heart failure (HF) as they engage in the complex processes of symptom monitoring, awareness, and evaluation. Aim: To explore difficulties in symptom perception and describe the characteristics of patients who consistently perceive HF symptoms. Methods: Using a convergent mixed methods design, we enrolled a purposeful sample of 40 adults with an unplanned hospitalization for HF symptom exacerbation. Quantitative data were obtained from the electronic health record and the Self-Care of Heart Failure Index (SCHFI v 7.2, scale scores 0-100, higher score = better self-care). Qualitative data from 1:1 semi-structured interviews exploring the symptom perception process were analyzed using directed content analysis. For data integration, individual difficulties in the SCHFI symptom perception processes of monitoring, awareness, and evaluation were anchored on the qualitative data. Two groups with different symptom perception consistency were identified from interviews. Group differences were examined using independent T, Mann-Whitney, Chi 2 , and Fisher’s Exact tests. Results: The sample was 50% male, 45% non-white, mean age 62 years, and 75% NYHA III-IV. Most (72.5%) demonstrated adequate symptom perception (SCHFI score ≥70). The consistent symptom perception group (n=27, 67.5%) had no difficulties in symptom monitoring, awareness, and evaluation while the inconsistent group reported insufficient symptom monitoring and/or inaccurate symptom evaluation. The consistent group was more experienced with HF and visited the emergency department more frequently in the past year. There were no group differences in age, gender, race, NYHA class, and HF stage (Table 1). Conclusion: Symptom perception interventions may be particularly useful early in the HF trajectory to enhance symptom monitoring and evaluation abilities.
Effective symptom perception may prevent unplanned hospitalizations. However, patients with heart failure (HF) often face challenges that interfere with symptom perception. Little is known about how patients perceive their HF symptoms. Aim: To describe how patients with HF perceive symptoms through the processes of monitoring, awareness, and evaluation. Methods: Using a qualitative descriptive design, we conducted semi-structured in-person interviews with a purposeful sample of adults experiencing an unplanned hospitalization for a HF symptom exacerbation. We elicited how patients monitor, become aware of, and evaluate symptoms prior to hospitalization. Data were analyzed using directed qualitative content analysis. We identified symptom monitoring behaviors, types of symptoms experienced, and success or failure in linking the symptoms to HF. Categories/subcategories were developed by grouping codes based on similarities and differences. Themes were conceptualized at a higher level of abstraction by combining categories. Results: A sample of 40 patients (mean age 62 years, 50% male, median HF duration 6 years, 95% HF stage C/D) was enrolled. Patients demonstrated Body listening , which was the use of active and individualized symptom monitoring tactics that involved observing for bodily changes outside one’s usual range. Trajectory of bodily change involved the patterns or characteristics of bodily changes as they became apparent. Three subthemes— sudden and stunning change , gradual change , and fluctuating change emerged as different Trajectories of bodily changes were identified. The same types of bodily changes could develop in different trajectories. Patients simultaneously experienced all or some of the trajectory types of various symptoms. Patients evaluated symptoms through an Exclusionary process , sequentially attributing symptoms to a cause through a cognitive process of excluding possible causes until the most plausible cause remained. Conclusion: Three major themes emerged from an in-depth description of the complex symptom perception processes of monitoring, awareness, and evaluation. Identifying where patients have difficulties in symptom perception will facilitate the development of tailored interventions.
