Background: Marginalized individuals in society are less motivated to care for themselves. Adequate self-care behavior is known to improve outcomes in patients with heart failure (HF), but the relationship between marginality and self-care has not been explored. Prior research suggests self-care confidence can influence self-care behavior.
Methods: We enrolled 287 community-living adults with any type of HF from inpatient settings and outpatient clinics in four northeastern and southern cities in the US and via an online national clinical research registry, ResearchMatch.com. Demographic data were used to calculate marginality scores as the sum of 3 variables: race (white, other, black), education (college, trade school, high school), and income adequacy (more than enough, enough, less than enough) for 9 total points; higher scores indicate higher marginality. All completed the Self-care of HF Index (SCHFI v7.1). We used self-care maintenance (reflects self-care behavior) and self-care confidence scales in the analysis. All SCHFI scale scores were standardized (0-100). Higher scores indicate better self-care and higher self-care confidence. Standard mediator and moderator analyses were performed.
Results: The sample was mainly white (78%), male (68%), with a mean age 62±13.5. We regressed self-care maintenance on marginality. There was a weak negative linear correlation (r = - 0.15, p < .05). For every 1 point increase in marginality, self-care maintenance decreased by 1.2 points. Self-care confidence predicted self-care maintenance (r=.52, p <.001), explaining 26.5% of the variance. Marginality failed to predict self-care confidence, so it was not a mediator. Self-care confidence was tested for moderation between self-care maintenance and marginality. Marginality and self-care confidence predicted self-care maintenance in a single regression model, explaining 28.1% of the variance. The interaction variable explained 4.4% of the variance in self-care maintenance (p < .001).
Conclusion: HF patients in marginalized groups are at risk for poor self-care maintenance, but this association is moderated by self-care confidence. Interventions that augment self-care confidence may be particularly important in marginalized groups.