Social Support is Important, but Self-Care Confidence is the Key for Better Treatment Adherence in Patients With Chronic Heart Failure Admitted With an Acute Exacerbation

Introduction: Adherence to treatment is crucial to improve outcomes in patients with heart failure (HF). Social support is associated with adherence, but the mechanism of this association is not well-explored. The purpose of this study was to examine whether self-care confidence mediates the relationship between social support and treatment adherence in patients admitted for acute exacerbation of HF symptoms.Methods: A total of 154 inpatients with HF recruited from two hospitals (62.8 ± 14 years, 51% female, 67% NYHA class III/IV) completed the Self-Care of Heart Failure Index to measure self-care confidence. Social support was measured by the Multidimensional Perceived Social Support Scale. Adherence to low salt diet, exercise and medication was measured using the Medical Outcomes Study Specific Adherence Scale. Clinical and demographic data were collected during patient interview. A series of regression models were used to determine mediation based on the Baron and Kenny method.Results: Controlling for marital status and hospital site, social support was associated with adherence (p= 0.03). When including, self-confidence, the effect of social support was reduced and became non-significant, indicating full mediation. The indirect effect (0.04) of social support on adherence through self-confidence was significant (95% CI= 0.01 - 0.09).Conclusion: HF self-care confidence mediated the relationship between social support and treatment adherence. This suggests that interventions targeting patients’ self-care confidence is essential to maximize patients’ adherence to their treatment regime