Iran Journal of Nursing

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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

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.