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Background Better caregiver contribution to self-care in heart failure is associated with better patient outcomes. However, caregiver contribution to self-care is also associated with high anxiety and depression, poor quality of life, and poor sleep in caregivers. It is still unclear whether interventions that encourage caregivers to contribute more to patient self-care might increase caregivers' anxiety and depression and decrease their quality of life and sleep. Objective The aim of this study was to assess the impact of a motivational interview intervention aimed at improving caregiver contribution to self-care in heart failure on caregivers' anxiety, depression, quality of life, and sleep. Methods This is a secondary outcome analysis of the MOTIVATE-HF trial. Patients with heart failure and their caregivers were randomized into arm 1 (motivational interview to patients), arm 2 (motivational interview to patients and caregivers), and arm 3 (standard care). Data were collected between June 2014 and October 2018. The article has been prepared following the Consolidated Standards of Reporting Trials checklist. Results A sample of 510 patient-caregiver dyads was enrolled. Over the year of the study, the levels of anxiety, depression, quality of life, and sleep in caregivers did not significantly change among the 3 arms. Conclusions Motivational interview aimed at improving caregiver contribution to self-care does not seem to increase caregiver anxiety and depression, nor decrease their quality of life and sleep. Thus, such an intervention might be safely delivered to caregivers of patients with heart failure, although further studies are needed to confirm our findings.

BackgroundThe recognition of a symptom is needed to initiate a decision to engage in a behavior to ameliorate the symptom. Yet, a surprising number of individuals fail to detect symptoms and delay in addressing early warnings of a health problem.PurposeThe aim of this study was to test the hypothesis that symptom recognition mediates the relationship between monitoring for and management of symptoms of a chronic illness.MethodsA secondary analysis of existing cross-sectional data. A sample of 1,629 patients diagnosed with one or more chronic conditions was enrolled in the United States (US) (n = 407), Italy (n = 784) and Sweden (n = 438) between March 2015 and May 2019. Data on self-care monitoring, symptom recognition, and self-care management was assessed using the Self-Care of Chronic Illness Inventory. After confirming metric invariance in cultural assessment, we used structural equation modeling to test a mediation model where symptom recognition was conceptualized as the mediator linking self-care monitoring and self-care management with autonomous (e.g., Change your activity level) and consulting behaviors (e.g., Call your healthcare provider for guidance).ResultsSymptom recognition mediated the relation between self-care monitoring and autonomous self-care management behaviors (β = 0.098, β = 0.122, β = 0.081, p < 0.001 for US, Italy, and Sweden, respectively). No mediation effect was found for consulting self-care management behaviors.ConclusionOur findings suggests that symptom recognition promotes autonomous self-care behaviors in people with a chronic condition. Self-care monitoring directly affects consulting self-care management behaviors but not through symptom recognition. Further research is needed to fully understand the role of symptom recognition in the self-care process.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Australian Catholic University, Australia Background Patients with heart failure or type 2 diabetes often experience bothersome symptoms (e.g., swelling, dizziness) and need clinical support with symptom management to reduce the impact of these symptoms. Knowledge about recommended self-care management behaviors by experienced clinicians can help to guide the development of more effective self-care interventions. Purpose To develop a list of common bothersome symptoms of heart failure and type 2 diabetes and of self-care management behaviors that clinicians recommend to patients to reduce the impact of these symptoms. Methods A two-round Delphi study among a panel of 37 nurses and physicians (heart failure only n=14; type 2 diabetes only n=11 and both heart failure and type 2 diabetes n=12) from Italy, the Netherlands, Sweden and the US was performed. Online surveys were used to identify common and bothersome symptoms and related self-care management behaviors that they recommend to patients with heart failure or type 2 diabetes. Self-care management behaviors that received at least 75% agreement were retained and similar self-care management behaviors were discussed and merged to reduce redundancy. Results For heart failure, the final list included 12 common bothersome symptoms (e.g., fatigue/tiredness, shortness of breath) and 51 related self-care management behaviors (e.g., balance rest & activity, check body weight & swelling). For type 2 diabetes, 11 common bothersome symptoms (e.g., hypo- and hyperglycemia symptom clusters, foot wounds) and 25 related self-care management behaviors (e.g., check blood sugar, take insulin, contact podiatrist) were included in the final list. Consensus was reached on the vast majority (70%) of recommended behaviors. Conclusion The lists of common bothersome symptoms and self-care management behaviors reflect consensus but also discrepancies between clinicians’ recommendations and current guidelines. Efforts to enhance and align the use of proven effective self-care management behaviors to reduce symptom impact in routine care by clinicians should be considered.

The situation-specific theory of caregiver contributions to heart failure (HF) self-care describes the processes that caregivers could use for HF self-care. The major concepts of the theory include: contributors, mediators, process, outcomes, and feedback loops. These major concepts are influenced by caregivers’ cultural values. The contributors are the factors related to caregivers, patients, and caregiver-patient dyads. The mediators include caregiver self-efficacy that mediates the interactions between the contributors and the process. The process that is the central focus of the theory includes the sub-concepts of caregiver contribution to self-care maintenance, caregiver contribution to symptom perception, and caregiver contribution to self-care management. The outcomes are related to caregivers’ and patients’ outcomes and can be positive or negative. Finally, the feedback loops are the influences of the outcomes on the process. The situation-specific theory of caregiver contributions to HF self-care is a new theory that needs more testing and utilization. However, it has great potential to be used in clinical practice, nursing education, and research since the prevalence and incidence rates of HF are increasing worldwide and lay caregivers have key roles in HF self-care.

Background. Knowledge of clinical and socio-demographic determinants of self-care in type 2 diabetes mellitus (T2DM) population is needed to identify patients at risk of poor self-care and to tailor effective interventions. Determinants of self-care, as defined by the middle-range theory of self-care of chronic illness, have not previously been investigated in T2DM. Aims. To describe self-care maintenance, monitoring, management and confidence and to identify their clinical and socio-demographic determinants in a T2DM population. Methods. A multicentre cross-sectional study was conducted involving 540 patients with a confirmed diagnosis of T2DM from 6 outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management and confidence dimensions. Scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. Results. Self-care maintenance (median = 81.2, Q1-Q3: 72.9-89.5) and self-care confidence (median = 79.5, Q1-Q3: 65.9-93.1) were adequate in most of the subjects. Self-care monitoring was adequate only in half of the sample (median = 70.5, Q1-Q3: 55.8-85.2). Self-care management was poor (median = 59.3, Q1-Q3: 39.7-75.0). Lower self-care maintenance was associated with lower self-care confidence (beta= 0.13; p

Background. Available self-care theories and qualitative research has identified values as an important influence on self-care in type 2 diabetes (T2DM) patients. However, values have never been quantitatively described in the T2DM population and the association between values and self-care has not been assessed. Aims. To investigate the association between values and self-care in adults with T2DM. Methods. A cross-sectional multicentre study was conducted in 6 outpatient diabetes services in a sample of 390 Italian T2DM patients. The Portrait Values Questionnaire (PVQ) was used to assess patients’ values, according to the Schwartz’s Theory of Basic Human Values. The PVQ measures 4 value dimensions in opposition: Self-Enhancement Vs Self-Transcendence, and Openness to Change Vs Conservation. A centred score is used to estimate individual priority between these dimensions; a positive score in one dimension means that this dimension is prioritized by the individual over the opposite one. The Self-care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence, according to the middle-range theory of self-care of chronic illness. Multiple quantile regression models were used to assess the associations between the 4 value dimensions and the 4 self-care dimensions, adjusting for clinical and sociodemographic variables. Results. The higher value dimensions were Self-Transcendence (centred score= 0.4) and Conservation (centred score= 0.3) while the lower were Self-Enhancement (centred score= -1.1) and Openness to Change (centred score= -0.1). Self-Enhancement was negatively associated with self-care maintenance (beta=-2.4; p=0.0085) and self-care monitoring (beta= -5.4; p=0.0005). Openness to Change was (borderline) negatively associated with self-care management (beta=-3.9; p=0.06). Conclusions. T2DM patients who value self-enhancement and openness to change may be less likely to adopt self-care behaviours then those who value conservation and self-transcendence. Interventions designed to maximize the values of conservation and self-transcendence may improve the self-care of T2DM patients

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Background. Self-care is essential for patients with diabetes mellitus (DM). Both clinicians and researchers must be able to assess the quality of that self-care. Available tools are not based on theory. Aim. To develop a new Self-Care of Diabetes Index (SCODI) based on the Middle-range Theory of Chronic Illness and test its psychometric performance. Methods. The 40 SCODI items (5 points Likert type) were developed based on the most recent evidence-based clinical recommendations and grouped into 4 dimensions: self-care maintenance (12 items), self-care monitoring (8 items), self-care management (9 items) and self-care confidence (11 items) based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients from Italy. Construct validity was evaluated by explorative factor analysis. Single factor and multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index (BMI), and presence of diabetes complications, were used for criterion validity. Test-retest reliability was assessed in a sub-group of 20 patients. Results. Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales (factor loadings range = 0.31 – 0.99). Single factor reliabilities were between 0.72 and 0.99. Multidimensional model based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of maintenance, monitoring and management (all p < 0.0001) confirming the theory. Intra-class correlation coefficient was > 0.9 for each of the 4 scales. Conclusion. The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients. It can be used both in research and clinical practice. SCODI testing in US (English version) and Brazilian (Portuguese version) diabetes populations is ongoing.