Self-Management Factors Among Rural-Dwelling Adults Living With Chronic Cardiovascular Disease

Abstract

Purpose: The purpose of this research is to describe self-management in rural dwelling adults living with Chronic Cardiovascular Disease (CCVD) and explore the associations between self-efficacy, patient activation, family support and strain, health behaviors, rurality, and self-management behaviors. Background: Cardiovascular disease (CVD) continues to be the leading cause of morbidity and mortality within the United States. According to the American Heart Association, by 2035, approximately 45% of the United States population will have a CVD diagnosis. The complexity of CVD management is compounded by rural living. Lack of proximate resources requires the patient to become an active agent, self-managing their disease and health care process. This research aimed to describe self-management in rural dwelling individuals with CCVD and further explored the associations among self-efficacy, patient activation, family support and strain, health behaviors, rurality and self-management behavior. Research Design: This study used a descriptive, cross-sectional quantitative research design. Methods: Study participants were recruited from rural health clinics within central California. All participants had an existing diagnosis of Hypertension (HTN) or Congestive Heart Failure (CHF) or both. Data was collected via a survey which included demographic information, and surveyed specific questions focusing around the dependent and independent variables of the study. An examination of the associations between self-efficacy, patient activation, family support and strain, health behaviors, rurality, and self-management behaviors were explored. Descriptive statistics were used to describe self-management in the study sample. Pearsons’ product moment correlation coefficients was used to calculate the association between the dependent variable of self-management with self-efficacy, patient activation, family support and strain, health behaviors, and rurality. Results: A total of 62 research participants were recruited, consented and participated in data collection for this study. Of the sample 61.3% (n=38) were female, 80% (n=50) identified as Hispanic or Latino. Participants ranged in age from 18 - 85+ years old, while the majority of participants ranged in age from 51-70 years old. The predominant level of education, marital status, employment status and years since diagnosis were as follows: less than high school completed at 62.9% (n=39), married 54.8% (n=34), unemployed 50% (n=31), and 6-10 years since cardiovascular disease diagnosis was 43.5% (n=27). Of all participants included in the study, 82% (n=51) had only a HTN diagnosis, 10% (n=6) had a diagnosis of both HTN and CHF, and 8% (n=5) had only a diagnosis of CHF. Self-Management was present in the study sample. An overall high score of Self-Management was reported by the study participants at 99% (n =59) reporting a score of 5 or greater, indicating “very easily” or “easily” to perform a Self-Management behavior. Self-management and self-efficacy showed the strongest linear relationship (r(60) = .82, p <.0001) out of all the independent variables. The weakest linear relationship was between Self-Management and patient activation (r(60) = .24, p <.05). Conclusions: The results of this study show the strongest relationship is between self-management and self-efficacy. Demonstrating the next steps in future study design, informing a deeper understanding of the role that self-management plays in rural dwelling adults with a CCVD diagnosis.