Impact of Health Literacy and Social Support on Self-Efficacy Regarding Self-Care among Patients with a Left Ventricular Assist Device (LVAD): Findings from the Mechanical Circulatory Support: Measures of Adjustment and Quality of Life (MCS A-QOL) Study

E. A. Hahn, K. Wortman, J. J. Teuteberg, J. D. Rich, C. W. Yancy, D. Cella, L. A. Allen, C. K. McIlvennan, M. S. Kiernan, J. Lindenfeld, L. Klein, C. M. Murks, C. S. Lee, Q. Denfeld, M. N. Walsh, B. Ruo, S. K. Buono, P. Cummings, K. L. Grady

Research output: Contribution to journalArticle

Abstract

PURPOSE: Patients with an LVAD face unique burdens in LVAD self-care (device management) in addition to heart failure (HF) self-care (diet, exercise, medications). We evaluated the impact of health literacy and social support on self-efficacy regarding self-care, and evaluated change in self-efficacy. METHODS: Patients at 9 centers enrolled in the study within 30 days prior to LVAD implantation. Assessments were at baseline and 3 and 6 months post-LVAD. Self-efficacy regarding HF self-care (13 items) and Self-efficacy regarding VAD self-care (12 items) used a 4-point scale: 1=not sure at all, 4=very sure of performing self-care activities. Health Literacy Assessment Using Talking Touchscreen Technology (10 items) was dichotomized as inadequate/low vs. adequate/high. Social support (emotional, instrumental, informational) was measured with PROMIS v2.0 (T-score of 50=general population mean). Participants who died, were transplanted, or were withdrawn before 6 months were excluded from analysis. Linear mixed effects models were estimated using all available longitudinal data, assuming a missing at random mechanism. RESULTS: The sample (n=126) was primarily male (72%), non-Hispanic White (62%) and had high health literacy (67%); mean (SD) age was 55 (11.7) years. Excluded participants (n=68) were similar on most variables (p>0.05). Emotional, instrumental and informational social support were substantially higher than the general population (mean (SD): 58 (7.6), 61 (6.4), 59 (8.7)) and positively associated with HF self-care efficacy and LVAD self-care efficacy (parameter estimates: 0.01-0.02; p<0.001). Health literacy was not associated with self-efficacy (p>0.05). Self-efficacy regarding HF self-care and VAD self-care were high and did not change over time (p>0.05): least-squares means (adjusted for social support and health literacy) at all assessments were 3.7 to 3.9. CONCLUSION: Social support was high and positively associated with higher self-efficacy regarding HF and VAD self-care. Strong social support might mitigate the impact of other risk factors, including low health literacy, on self-efficacy. More research is needed to understand these factors in a more diverse patient group.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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