Knowledge, attitudes and practices towards worsening heart failure among caregivers of older adults with chronic heart failure: a cross-sectional study in Guangzhou, China

OBJECTIVES: This study aimed to investigate the knowledge, attitude and practice (KAP) towards worsening heart failure (WHF) among caregivers for older adults with chronic heart failure (CHF). DESIGN: A cross-sectional study was conducted between September and October 2023. PARTICIPANTS: The study involved caregivers for older adults living with CHF in Guangzhou, China. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes included KAP scores regarding WHF, while secondary outcomes involved the relationships among knowledge, caregiver strain, attitude and practice. RESULTS: A total of 538 valid questionnaires were included, with 326 (60.59%) caregivers being female. The median KAP scores were 30 (23-45) (possible range: 0-54), 42 (36-45) (possible range: 9-45) and 36 (29-41) (possible range: 9-45), respectively, indicating insufficient knowledge, positive attitude and moderate practice. Path analysis indicated that knowledge directly influenced attitude (β=0.213, p<0.001), caregiver strain (β=0.008, p<0.001) and practice (β=0.105, p<0.001). Furthermore, attitude (β=0.378, p<0.001) and caregiver strain (β=3.408, p<0.001) also had direct effects on practice. Mediation analysis revealed that the effect of knowledge on practice is mediated through attitude (r=0.081, p=0.005) and caregiver strain index (r=0.027, p=0.012). CONCLUSIONS: Caregivers of older adults living with CHF exhibited insufficient knowledge, positive attitudes and moderate practices regarding WHF. This study underscores the necessity for tailored interventions to bridge knowledge gaps, promote positive attitudes and enhance practical skills among caregivers, ultimately improving WHF management in older adults.