Perceived Control Mediates the Relationship Between Fatigue and Self-Care in Patients With Heart Failure

BACKGROUND: Fatigue makes daily tasks difficult for patients with heart failure (HF); however, its impact on self-care has not been reported. In addition, self-efficacy, self-care confidence, and perceived control are psychological determinants of self-care in patients with HF. The mechanisms by which these cognitive aspects influence self-care have not been fully investigated. AIM: The aim in this study was to determine whether perceived control mediates the relationship between fatigue and self-care in patients with HF. METHODS: We conducted a secondary analysis (n = 165) of a cross-sectional, observational study in which patients were enrolled between February and August 2018 in Japan. We used the Brief Fatigue Inventory to measure fatigue; the Self-care of Heart Failure Index for self-care maintenance, management, and confidence; and the Control Attitude Scale Revised for perceived control. The PROCESS macro was used to assess mediation. RESULTS: Fatigue had no direct effect on self-care maintenance, management, or confidence (effect coefficient [ c ] = 0.410; 95% confidence interval [CI], -1.039 to 1.858, c = 1.594; 95% CI, -0.412 to 3.601, c = 0.478; 95% CI, -1.041 to 1.997). There was, however, an indirect pathway between fatigue and self-care maintenance, management, and confidence through perceived control ( a * b = -0.395; 95% CI, -0.936 to -0.040, a * b = -0.749; 95% CI, -1.574 to -0.090, a * b = -1.064; 95% CI, -2.086 to -0.181). CONCLUSIONS: Perceived control mediates the association between fatigue and self-care, improving perceived control as a key component to reduce the impact of fatigue on self-care.