پیش بینی رفتارهای خودمراقبتی و کیفیت زندگی بر اساس درک از بیماری در افراد با نارسایی قلبی

زمینه و هدف: ادراک بیماری می‌تواند بر سلامت روان فرد و نحوه برخورد بیماران با بیماری تاثیر می‌گذارد و بدین ترتیب رفتارهای خودمراقبتی و کیفیت زندگی را تحت تاثیر قرار دهد. هدف از این مطالعه پیش بینی رفتارهای خودمراقبتی و کیفیت زندگی براساس درک از بیماری افراد با نارسایی قلبی بود.روش بررسی: این مطالعه مقطعی از نوع همبستگی پیش بین از دی ماه 1396 تا اردیبهشت 1397 بر روی 150 بیمار مبتلا به نارسایی قلب که به روش مستمر انتخاب شدند انجام گردید. داده‌ها به صورت خود گزارش‌دهی با استفاده از پرسشنامه اروپایی رفتارهای مراقبت از خود در بیماران نارسایی، پرسشنامه کوتاه درک از بیماری و پرسشنامه زندگی با نارسایی قلبی مینه‌سوتا جمع آوری شدند. جهت تحلیل داده‌ها از ضریب همبستگی پیرسون، آزمون آنالیز واریانس، کای اسکوئر، تی‌مستقل و ضریب تعیین در نرم افزارspss نسخه 16 استفاده شد. یافته‌ها: براساس نتایج، میانگین نمرات درک از بیماری با hf برابر با 7.86 ± 59.42 بود. میانگین رفتارهای خودمراقبتی 7.79 ± 36.24 (با بیشینه و کمینه 1553) بدست آمد که نشاندهنده خودمراقبتی در سطح متوسط بیماران است. کمترین و بیشترین نمره کیفیت زندگی به ترتیب برابر با 0 و 97 با میانگین 16.84 ± 59.53 (بالاتر از میانه نمره ابزار) بود بدین معنا که کیفیت زندگی واحدهای مورد پژوهش در سطح ضعیف قرار داشت. بر اساس نتایج 12 درصد از تغییرات رفتارهای خودمراقبتی و 42 درصد از تغییرات نمره کیفیت زندگی تحت تاثیر درک از بیماری براساس مشخصات جمعیت شناختی تبیین شده‌اند. نتیجه‌گیری کلی: با توجه به یافته‌ها، درک از بیماری پیش ‌بینی کننده کیفیت زندگی و رفتارهای خودمراقبتی است. کارکنان سلامت مخصوصاّ پرستاران که در ارتباط بیشتری با بیماران هستند می‌توانند با آموزش بیماران در جهت بهبود ادراک بیماران تلاش نمایند تا در نهایت خودمراقبتی و کیفیت زندگی آنها افزایش یابد.

The Prediction of Self-care Behaviors and Quality of Life Based on Disease Perception in Patients with Heart Failure

Background Aims: Heart failure (HF) is a disorder that is caused by the inability of the heart to pump blood properly due to the disorders in the structure or function of the heart. Quality of life (QOL) is lower in patients with HF compared to the general population and patients with other chronic diseases. For optimal QOL, it is necessary to change behaviors and follow treatment regimens throughout the period of selfcare. The impact of any chronic and longterm condition on the patients and their ability to optimize selfcare could be attributed to several factors, such as the understanding of the condition and its nature, impact of the condition on the ability of the patient to perform daily activities, beliefs and expectations, patientchr('39')s involvement in selfcare, and support. Disease perception could affect the mental health of the patients and management of the disease, thereby affecting their selfcare behaviors and QOL. The present study aimed to predict the selfcare behaviors and QOL based on the disease perception of patients with HF.Materials Methods: This crosssectional was conducted with a predictive correlational design during January 2017May 2016 on 150 patients with HF, who were selected via continuous sampling based on the inclusion criteria of the confirmed diagnosis of HF by a physician and a minimum of six months past the disease, age of more than 18 years, and ability to communicate and literacy to complete the questionnaires. Data were collected in a selfreport manner using the European HF selfcare behavior scale, a brief illness perception questionnaire, and Minnesota living with heart failure questionnaires. The European HF selfcare behavior scale consists of 12 items, and the responses are scored based on a fivepoint Likert scale (Completely=1, Not at All=5) within the score range of 1260. The lower scores in this questionnaire show the better selfcare behavior of individuals and vice versa. The brief illness perception questionnaire has eight items, which were prepared based on the modified version of the questionnaire. The items are scored within the range of 010, and the score obtained from the eight items is within the range of 080, which is the highest score indicating the patientchr('39')s understanding of the high risk of the disease. The Minnesota living with heart failure questionnaires has 21 items that are scored based on a sixpoint Likert scale (05), and the total score is within the range of 0105, and the higher scores show the lower QOL of the patient. Data analysis was performed in SPSS version 16 using Pearsonchr('39')s correlationcoefficient, the analysis of variance (ANOVA), Chisquare, independent ttest, and regression analysis.Results: The mean score of the illness perception was 59.42 ±7.86, the mean score of selfcare behaviors was 36.24 ±7.79 (moderate), and the mean score of QOL was 59.53 ±16.84 (poor). A significant, direct, and weak correlation was observed between the illness perception and selfcare behaviors (P<0.001; r=0.26). In addition, selfcare was the only predictor of illness perception, and illness perception and QOL had a direct, significant correlation (r=0.48; P<0.001). The results of multiple linear regression analysis showed that illness perception, adequate income, education level, number of hospitalizations, and classification of HF were the predictors of QOL. The mean score of the illness perception was 59.42 ±7.86, and the mean score of selfcare behaviors was 36.24 ±7.79 (maximum: 53, minimum: 15), which indicated the moderate selfcare of the patients. The minimum and maximum scores of QOL were zero and 97, respectively with the mean score of 59.53 ±16.84, which indicated the poor QOL of the research units. A weak, significant correlation was observed between the illness perception and selfcare of the patients (r=0.26; P<0.001), so that with the increased score of illness perception, the selfcare scores of the patients increased. In the results of the multiple linear regression analysis indicated that the only selfcare could predict selfcare (P=0.046), so that with the increased score of illness perception by one point, the selfcare scores of the patients increased by 0.15 units. Therefore, when the patient is threatened to perceive their disease, their selfcare becomes weaker (Table 2). In addition, the correlation between the two variables of illness perception and QOL was direct and significant (P<0.001; r=0.48). As the scores of disease perception increased, the QOL of the patients was higher, so that the more the patient perceives the threat of the disease, the poorer their QOL becomes. The results of multiple linear regression analysis indicated that per one unit of increase in the perception of the disease, the QOL score increased by 0.33, which shows the deterioration of the QOL. The QOL in those with sufficient income was lower by 0.14 compared to those with insufficient income. Furthermore, the QOL score of those with an undergraduate degree (below diploma) was lower by 0.22 compared to those with higher education. The patients without the history of hospitalization had higher QOL scores by 0.31 compared to those with 510 hospitalizations, indicating the better QOL. In addition, the QOL score of the patients with HF class II was lower by 0.29 units and 0.16 units in those with HF class III compared to those with HF class IV, which indicated their better QOL.Conclusion: According to the results, illness perception predicts QOL and selfcare behaviors. In this study, patients with HF, which is a common chronic disease, were examined. In these patients, the perception and cognition that a person is affected by other factors of his disease affects the perception of their physical needs, followed by their activities and the behaviors that influence selfcare and meeting needs. However, it should be noted that in addition to illness perception, other factors play a key role in the selfcare of patients with HF, which must be investigated in the future studies. The healthcare professionals (especially nurses) who are more in contact with patients could improve the patientschr('39') perceptions through education to increase their selfcare and QOL. The patients with poor illness perception had more negative selfcare behaviors. The healthcare professionals (especially nurses) who are more in contact with patients could improve the patientschr('39') perceptions through education to increase their selfcare. The results showed that poor illness perception was associated with the lower QOL. Therefore, it is suggested that interventions such as counseling and followup programs be considered to improve the understanding of diseases, so that QOL could be enhanced. Research must be focused on the effectiveness of these interventions. Considering the association between illness perception and selfcare behaviors in the HF patients and the predictive role of disease perception (especially for QOL), nursing managers could provide facilities for planning and implementing the necessary measures to improve the patientchr('39')s understanding of HF upon admission and referral to medical centers or the proper conditions should be provided for the implementation of counseling and followup sessions in the management of the patients at home.