Identification of factors associated with self-care behaviors using the COM-B model in patients with chronic heart failure

BACKGROUND: Self-care can improve heart failure outcomes. Self-care confidence is associated with self-care behaviors and may serve as a mediator between potential influencing factors (e.g. functional capacity, knowledge, and health literacy) and self-care behaviors. However, evidence is limited on these relationships. The COM-B model (consisting of capability, opportunity, and motivation) may be an appropriate framework to understand the above relationships. AIM: The purpose of this study was to explore factors associated with self-care behaviors and to examine the mediating role of self-care confidence. METHODS: Three hundred and twenty-one patients (mean age 64 years, 51% male) with chronic heart failure completed measures of functional capacity, knowledge, health literacy, social support, socioeconomic status, self-care, and sociodemographic and clinical characteristics. Structural equation modeling was used to analyze the data. RESULTS: The scores for self-care maintenance and management were 48.4±15.9 and 54.3±19.3, respectively. The revised model showed good fit (root mean square error of approximation=0.029; comparative fit index=0.989). Functional capacity and knowledge were directly associated with self-care management, and health literacy and social support were directly related to self-care maintenance. Moreover, self-care confidence mediated the relationships between knowledge, health literacy, social support and self-care behaviors. CONCLUSIONS: Chinese patients with chronic heart failure have poor self-care behaviors. Factors associated with self-care behaviors are confidence, functional capacity, knowledge, health literacy and social support. Self-care confidence appears to be a mediator between knowledge, health literacy, social support and self-care behaviors. Targeted interventions are required to optimize self-care behaviors in patients with chronic heart failure.