Factors associated with heart failure patients' views of participation in care

Purpose: Participation of patients with chronic heart failure (CHF) in their care is important for improving outcomes. The aim of this study was to explore factors that were associated with patient views of the importance of involvement and participation in care. Methods: Baseline data from 100 CHF patients enrolled to home care in Sweden were used. A linear regression analysis, using enter method, was performed with three subscales (participation, information and needs) of a questionnaire measuring patient views of involvement in care, as the dependent variable. Socio-demographic (age, education, gender, home help service, co-habiting, smoking, alcohol) and clinical characteristics (NYHA-class, co-morbidities measured by Charlson Comorbidity Index), health (EuroQoL 5D), perceived control (Control Attitude Scale), and self-care behavior (European Self-Care Behavior Scale) were included to determine independent factors associated with participation. Results: Sixty-two percent were men, mean age 82 years, the majority (80%) was in NYHA-class III. Patients scored a mean level of 7.6 ± 2.0 (theoretical range 1-10) for the satisfaction of their participation in heart failure care. The regression analysis showed that patients view of the importance of participation was significantly associated with co-habiting (β = 0.25, t = 2.09 p = 0.04) and self-care behavior (β = -0.33, t = -3.44, p < 0.001). These variables explained 22% of the variance of importance of participation. The degree to which patients stated that they had received information about CHF and treatment was significantly related to gender (β = -0.23, t = -2.22, p = 0.03), self-care behavior (β = -0.42, t = -4.34, p < 0.001) and knowledge (β = 0.24, t = 2.25, p = 0.03). These variables explained 21% of the variance of information subscale. Meeting patients need regarding questions and respect was significantly associated with symptoms of depression (β = -0.25, t = -2.29, p = 0.02), self-care behavior (β = -0.37, t = -3.95, p < 0.001) and knowledge (β = 0.23, t = 2.25, p = 0.03). These variables explained 22% of the variance. Conclusion: Patient views of involvement, receiving information, ability to ask questions and being treated with respect were strongly associated with self-care behavior. Other factors influencing satisfaction with involvement and participation were higher level of knowledge, lower degree of depressive symptom, male gender and co-habiting. Interventions that focus on participation to improve self-care seem promising and need to be studied