Volume 32, Issue 119 (August 2019)                   IJN 2019, 32(119): 26-40 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Najafi Ghezeljeh T, Ghasemi A, Rasouli M, Garak Yaraghi M. Evaluation of the Relationship between Self-care Behaviors and Anxiety, Family Support and Disease State in Patients with Heart Failure and Type II Diabetes Mellitus Admitted to Chamran Teaching Health Center in Isfahan, Iran in 2018. IJN 2019; 32 (119) :26-40
URL: http://ijn.iums.ac.ir/article-1-2950-en.html
1- Associate Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- MS in Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel:09376443016 Email: atiyeghasemi16@yahoo.com
3- Assistant Professor, Department of Statistics, Iran University of Medical Sciences, Tehran, Iran
4- Professor, Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract:   (4621 Views)
Background & Aim: Heart failure is a prevalent, chronic disease in developing countries, and type II diabetes mellitus is considered to be a major cause of heart failure. In addition to increasing atherosclerosis and contributing to hypertension, diabetes changes heart function and structure, which results in heart failure. An effective approach to the control of these diseases is the active participation of patients in self-care since it will improve the participation, satisfaction with treatment, and quality of life of patients while decreasing their anxiety levels. Self-care behaviors are extremely important in patients with chronic diseases since they empower patients in terms of performance and increase their ability to deal with problems and have a healthy lifestyle. However, self-care can be affected by factors related to the patient, community, and environment. These factors can include social support and medical staff care. In patients with heart failure, self-care is often affected by various factors, which can be used to describe and determine this complicated syndrome. However, the concurrence of heart failure and diabetes is associated with complex and difficult self-care behaviors. Therefore, it is essential to identify the influential factors in self-care behaviors. The present study aimed to assess the correlations between self-care behaviors and anxiety, family support, and disease state in patients with heart failure and type II diabetes. 
Materials & Methods: This descriptive-correlational study was conducted on 158 patients with heart failure and type II diabetes mellitus referring to Chamran Hospital in Isfahan, Iran in 2018. The patients were selected via continuous sampling, and inclusion criteria were age above 18 years, diagnosis of heart failure by a cardiologist based on echocardiography, lack of experience of acute coronary syndromes in the last three months, and obtaining a score above 10 in mini-mental state examination test (MMSE). Data were collected using the European heart failure self-care behavior scale (EHFSCB), Charlson comorbidity index (CCI), MMSE, Perceived Social Support from Family (PSS-Fa), and Spielberger state-trait anxiety inventory (STAI) on the last day of hospitalization (before discharge). Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, frequency percentage, mean, and standard deviation), inferential statistics (t-test and analysis of variance), Pearson’s correlation (to determine correlation), and Kolmogorov-Smirnov test (to determine the normal distribution of the data).
Results: In this study, 8.2% of the subjects had poor self-care behaviors, whereas 88.6% and 3.2% had moderate and good self-care behaviors, respectively. In this regard, the mean and standard deviation of self-care was reported to be 38.37 and 4.76, respectively, which demonstrated that the mean self-care scores were at a moderate level. According to the results, there was no significant correlation between the demographic and disease characteristics of the patients and self-care behaviors (P>0.05). Moreover, most participants received a disease status score of three-four, and the mean disease status score was estimated at 4.69 ± 1.91. Furthermore, we detected no significant relationship between disease status score and self-care behaviors (P=0.55). According to the results, the majority of subjects (47.5%) had a moderate cognitive performance state and their scores were in the range of 10-20. In addition, the mean cognitive performance score of the subjects was reported to be 19.16 ± 4.82, and no significant association was found between the mentioned variable and self-care behaviors. According to the results of the present study, the highest percentage frequency in the area of obvious anxiety was related to moderate-low anxiety (25.3%). On the other hand, no significant correlation was observed between obvious anxiety and self-care behaviors. Regarding latent anxiety, the highest frequency (29.1%) was related to moderate-high anxiety, and no significant association was observed between hidden anxiety and self-care. Furthermore, the mean family support was estimated at 11.61 ± 5.35, and no significant relationship was found between the foregoing variable and self-care behaviors. 
Conclusion: According to the results, the self-care scores of the subjects were at a moderate level, and no significant correlation was observed between demographic and disease variables of the participants and their self-care behaviors. Our findings were also indicative of no significant relationship between disease status and self-care behaviors, and other variables affected self-care behaviors with the exception of other illnesses. We found no relationship between cognitive performance status and self-care behaviors. According to the results, there was no correlation between self-care behaviors and the variables of anxiety and family support. In the present study, a few participants had good self-care behaviors, which requires healthcare team members, especially nurses, to make efforts in the area of patient education and following up the performance of these behaviors in order to reduce mortality rates and treatment costs in this group of patients. In the current research, we found no association between demographic and disease variables, disease status, cognitive performance status, anxiety, and family support with self-care behaviors. Given the fact that self-care is the most important strategy for disease control and the key to successful treatment in patients with heart disease and type 2 diabetes, and since any progress in the treatment depends on the patient’s self-care and treatment outcome management abilities, investigations must continue on the influential factors in self-care behavior in order to change the attitudes of patients in this regard.
Full-Text [PDF 951 kb]   (1660 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2019/05/8 | Accepted: 2019/08/7 | Published: 2019/08/7

References
1. Halmo R, Galuszka J, Langova K, Galuszkova D. Self care in patients with chronic heart failure. Pilot study-self care includes problems. Biomedical Papers. 2015;159(1):124-30. [DOI:10.5507/bp.2013.044] [PMID]
2. Riegel B, Lee CS, Dickson VV. Self care in patients with chronic heart failure. Nat Rev Cardiol. 2011;8(11):644-54. [DOI:10.1038/nrcardio.2011.95] [PMID]
3. Black JT, Romano PS, Sadeghi B, Auerbach AD, Ganiats TG, Greenfield S, Kaplan SH, Ong MK, Beat-HF Research Group. A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition-Heart Failure (BEAT-HF) randomized controlled trial. Trials. 2014;15(1):124. [DOI:10.1186/1745-6215-15-124] [PMID] [PMCID]
4. Lee CS, Bidwell JT, Paturzo M, Alvaro R, Cocchieri A, Jaarsma T, Strömberg A, Riegel B, Vellone E. Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up. Heart & Lung. 2018;47(1):40-6. [DOI:10.1016/j.hrtlng.2017.09.004] [PMID] [PMCID]
5. Horwich TB, Fonarow GC. Glucose, obesity, metabolic syndrome, and diabetes: relevance to incidence of heart failure. J Am Coll Cardiol. 2010;55(4):283-93. [DOI:10.1016/j.jacc.2009.07.029] [PMID] [PMCID]
6. Kassahun T, Gesesew H, Mwanri L, Eshetie T. Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey. BMC Endocr Disord. 2016;16(1):28. [DOI:10.1186/s12902-016-0114-x] [PMID] [PMCID]
7. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137-49. [DOI:10.1016/j.diabres.2013.11.002] [PMID]
8. Hemmati Maslak Pak M, Alipor S, Aghakhani N, Khalkhali H. The Effect of Family Centered Care on Laboratory Examinations in Patients with Type Ii Diabetes. Journal of Urmia Nursing And Midwifery Faculty. 2017;15(5):395-403.
9. Cha E, Clark PC, Reilly CM, Higgins M, Lobb M, Smith AL, Dunbar SB. Educational needs for improving self-care in heart failure patients with diabetes. Diabetes Educ. 2012;38(5):673-84. [DOI:10.1177/0145721712450923] [PMID] [PMCID]
10. Mirzaei M, Aspin C, Essue B, Jeon YH, Dugdale P, Usherwood T, Leeder S. A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness. BMC Health Serv Res. 2013;13(1):251. [DOI:10.1186/1472-6963-13-251] [PMID] [PMCID]
11. Dunbar SB, Butts B, Reilly CM, Gary RA, Higgins MK, Ferranti EP, Culler SD, Butler J. A pilot test of an integrated self-care intervention for persons with heart failure and concomitant diabetes. Nursing outlook. 2014;62(2):97-111. [DOI:10.1016/j.outlook.2013.09.003] [PMID] [PMCID]
12. Ausili D, Rebora P, Di Mauro S, Riegel B, Valsecchi MG, Paturzo M, Alvaro R, Vellone E. Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: A multicentre cross-sectional study. Int J Nurs Stud. 2016;63:18-27. [DOI:10.1016/j.ijnurstu.2016.08.006] [PMID]
13. Dunbar SB, Reilly CM, Gary R, Higgins MK, Culler S, Butts B, Butler J. Randomized clinical trial of an integrated self-care intervention for persons with heart failure and diabetes: quality of life and physical functioning outcomes. J Card Fail. 2015;21(9):719-29. [DOI:10.1016/j.cardfail.2015.05.012] [PMID] [PMCID]
14. Schulman‐Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, Redeker NS, Reynolds N, Whittemore R. Processes of self‐management in chronic illness. J Nurs Scholarsh. 2012;44(2):136-44. [DOI:10.1111/j.1547-5069.2012.01444.x] [PMID] [PMCID]
15. King DK, Glasgow RE, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, Faber AJ. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes care. 2010;33(4):751-3. [DOI:10.2337/dc09-1746] [PMID] [PMCID]
16. Bidwell JT, Vellone E, Lyons KS, D'Agostino F, Riegel B, Juárez‐Vela R, Hiatt SO, Alvaro R, Lee CS. Determinants of heart failure self‐care maintenance and management in patients and caregivers: a dyadic analysis. Research in nursing & health. 2015;38(5):392-402. [DOI:10.1002/nur.21675] [PMID] [PMCID]
17. Cocchieri A, Riegel B, D'Agostino F, Rocco G, Fida R, Alvaro R, Vellone E. Describing self-care in Italian adults with heart failure and identifying determinants of poor self-care. Eur J Cardiovas Nurs. 2015;14(2):126-36. [DOI:10.1177/1474515113518443] [PMID]
18. Bhandari P, Kim M. Self-care behaviors of nepalese adults with type 2 diabetes: a mixed methods analysis. Nursing research. 2016;65(3):202-14. [DOI:10.1097/NNR.0000000000000153] [PMID]
19. Mahboobeh VA, Nasli-Esfahani E, Peimani M, Sanjari M, Arzaghi SM, Larijani B. Iran diabetes research roadmap (IDRR) study; mental health in diabetic patients in Iran: a review article. Iran J Public Health. 2017;46(Supple 1):47-52.
20. Vellone E, Fida R, D'Agostino F, Mottola A, Juarez-Vela R, Alvaro R, Riegel B. Self-care confidence may be the key: a cross-sectional study on the association between cognition and self-care behaviors in adults with heart failure. Int J Nurs Stud. 2015;52(11):1705-13. [DOI:10.1016/j.ijnurstu.2015.06.013] [PMID]
21. Buck HG, Dickson VV, Fida R, Riegel B, D'Agostino F, Alvaro R, Vellone E. Predictors of hospitalization and quality of life in heart failure: A model of comorbidity, self-efficacy and self-care. Int J Nurs Stud. 2015;52(11):1714-22. [DOI:10.1016/j.ijnurstu.2015.06.018] [PMID]
22. Bohanny W, Wu SF, Liu CY, Yeh SH, Tsay SL, Wang TJ. Health literacy, self‐efficacy, and self‐care behaviors in patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract. 2013;25(9):495-502. [DOI:10.1111/1745-7599.12017] [PMID]
23. Salehzadeh A, Rahmatpour P. Self-care behaviors and related factors in patients with heart failure reffering to‎ medical & educational center of heart in Rasht.‎. Journal of Holistic Nursing And Midwifery. 2013;23(1):22-9.
24. Jaarsma T, Strömberg A, Mårtensson J, Dracup K. Development and testing of the European heart failure self‐care behaviour scale. Eur J Heart Fail. 2003;5(3):363-70. [DOI:10.1016/S1388-9842(02)00253-2]
25. Shojaei F, Asemi S, Najaf YA, Hosseini F. Self-care behaviors in patients with heart failure. Payesh journal. 2009;8(4):361-9.
26. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. [DOI:10.1016/0021-9681(87)90171-8]
27. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189-98. [DOI:10.1016/0022-3956(75)90026-6]
28. S Seyedian M, Falah M, Nourozian M. Provide and specify Persian version credit, Short test of mental status. Iran Journal of Medical Council. 2007;4(25):40-1.
29. Marteau TM, Bekker H. The development of a six‐item short‐form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992;31(3):301-6. [DOI:10.1111/j.2044-8260.1992.tb00997.x]
30. Mahram B. Validity of Spielberger state-trait anxiety inventory (STAI) in Mashhad city. Tehran: Allameh Tabatabaei University. 1993.
31. Procidano ME, Heller K. Measures of perceived social support from friends and from family: Three validation studies. Am J Community Psychol. 1983;11(1):1-24. [DOI:10.1007/BF00898416]
32. Sayah Sayari N, Hossein Shahi HR, Ranjgar B. Relationship between Adolescents' Identity and Parents' Social Support. Journal of Clinical Psychology Andishe va Raftar (Andisheh va Raftar) (Applied Psychology). 2010;4(16):67-74.
33. Farghadani Z, Taheri KZ, Amiri MA, Montazeri A. Self-Care Behaviors and its Related Factors in Patients with Heart Failure. PAYESH. 2018;17(4):371-9.
34. Kato N, Kinugawa K, Nakayama E, Tsuji T, Kumagai Y, Imamura T, Maki H, Shiga T, Hatano M, Yao A, Miura C. Insufficient self-care is an independent risk factor for adverse clinical outcomes in Japanese patients with heart failure. Int Heart J. 2013;54(6):382-9. [DOI:10.1536/ihj.54.382] [PMID]
35. Hu X, Hu X, Su Y, Qu M, Dolansky MA. The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure. Patient Prefer Adherence. 2015;9:1593-601. [DOI:10.2147/PPA.S88431] [PMID] [PMCID]
36. Kessing D, Denollet J, Widdershoven J, Kupper N. Self-care and all-cause mortality in patients with chronic heart failure. JACC: Heart Failure. 2016;4(3):176-83. [DOI:10.1016/j.jchf.2015.12.006] [PMID]
37. Uchmanowicz I, Jankowska-Polańska B, Mazur G, Froelicher ES. Cognitive deficits and self-care behaviors in elderly adults with heart failure. Clin Iinterv Aging. 2017;12:1565-72. [DOI:10.2147/CIA.S140309] [PMID] [PMCID]
38. Kh M, Hasavari F, Sedghi Sabet M, Kazemnejad-Leili E, Gholipour M. Self-Care Status and Its Related Factors in Patients with Heart Failure. Journal of Health and Care. 2018;19(4):232-41.
39. Trojahn MM, Ruschel KB, Nogueira de Souza E, Mussi CM, Naomi Hirakata V, Nogueira Mello Lopes A, Rabelo-Silva ER. Predictors of better self-care in patients with heart failure after six months of follow-up home visits. Nursing research and practice. 2013;2013. [DOI:10.1155/2013/254352] [PMID] [PMCID]
40. Cené CW, Haymore LB, Lin FC, Laux J, Jones CD, Wu JR, DeWalt D, Pignone M, Corbie-Smith G. Family member accompaniment to routine medical visits is associated with better self-care in heart failure patients. Chronic illness. 2015;11(1):21-32. [DOI:10.1177/1742395314532142] [PMID]

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2015 All Rights Reserved | Iran Journal of Nursing

Designed & Developed by : Yektaweb