The relationship between mutuality and contributions to self-care in family caregivers of patients with heart failure: multiple mediating effects of resilience and self-efficacy

Abstract

Aims Previous studies have indicated a positive association between mutuality and caregiver contributions to heart failure self-care (CC-HFSC). However, little is known about the underlying mechanisms in the relationship. This study aimed to determine whether resilience and self-efficacy play multiple mediating roles in the association between mutuality and CC-HFSC. Methods and results In this cross-sectional, correlational study, a self-reported survey was conducted in 259 patient–caregiver dyads recruited from two hospitals in China using a convenience sampling method. Better mutuality (r = 0.27, P < 0.01), resilience (r = 0.23, P < 0.01), and self-efficacy (r = 0.34, P < 0.01) were correlated with greater CC-HFSC maintenance. Better mutuality (r = 0.29, P < 0.01), resilience (r = 0.20, P < 0.01), and self-efficacy (r = 0.35, P < 0.01) were correlated with greater CC-HFSC management. In multiple mediation models, self-efficacy independently [effect = 0.061, 95% confidence interval (CI) (0.024–0.119)] and resilience and self-efficacy serially [effect = 0.017, 95% CI (0.007–0.036)] mediated the association between mutuality and CC-HFSC maintenance. Meanwhile, self-efficacy independently [effect = 0.058, 95% CI (0.020–0.113)] and resilience and self-efficacy serially [effect = 0.018, 95% CI (0.007–0.038)] mediated the association between mutuality and CC-HFSC management. Conclusions Resilience and self-efficacy were multiple mediators in the association between mutuality and CC-HFSC. Interventions targeting the facilitation of mutuality, and then increasing resilience and self-efficacy may be beneficial for improving CC-HFSC.

Association Between Benefit Finding and Self-care Management in Heart Failure Patient-Caregiver Dyads

“…In the meanwhile, we found that caregivers' mutuality partially mediated the actor effect of their own benefit finding on contributions to self-care management. Previous studies have indicated that benefit finding was positively related to mutuality in caregivers of patients with HF, 34 and caregivers' mutuality was positively associated with their contributions to HF self-care management 29 . Our results confirmed the positive association between benefit finding and mutuality, the positive association between mutuality and self-care management, and the mediation effect of mutuality between benefit finding and self-care management in patients with HF as well as in their family caregivers.…”

“…61 When facing illness, patients' positive responses could cause caregivers to experience more emotional support and higher self-gain from caregiving, thus improving their perceived mutuality with patients and inspiring them to overcome obstacles in HF management. 23,29,62 In summary, our findings emphasized the significance of mutuality and the interplay between HF patient-caregiver dyads, providing new paths for enhancing dyadic benefit finding and mutuality to improve patients' self-care management and caregivers' contributions to self-care management. This study brought some implications for research and practice.…”

“…Influenced by Confucianism, Chinese caregivers usually take caregiving for sick family members as their moral obligation 61 . When facing illness, patients' positive responses could cause caregivers to experience more emotional support and higher self-gain from caregiving, thus improving their perceived mutuality with patients and inspiring them to overcome obstacles in HF management 23,29,62 …”

“…27,28 In recent years, mutuality within HF patient-caregiver dyads has gained increasing attention. Previous studies have revealed that better mutuality is associated with better self-care, 11,29,30 reduced anxiety and depression, 31 and improved quality of life 32 in patients with HF and their caregivers. For HF self-care management, Bidwell et al 13 reported the positive association between patients' mutuality and their own self-care management, and the positive association between caregivers' mutuality and their contributions to self-care management; Vellone et al 11 found that higher patients' mutuality predicted better caregivers' contributions to self-care management.…”

Social support and self-efficacy multiply mediate the relationship between medical coping style and resilience in patients with type A aortic dissection

“…According to Bandura’s theory, self-efficacy refers to an individual’s belief in one’s ability to engage in healthy activities ( 18 ). Self-efficacy is a protective factor of resilience and is significantly correlated with medical coping modes ( 19 , 20 ). Adopting positive coping styles can improve patients’ self-efficacy, making them more confident in their ability to face the disease and seek help from others.…”