Effect of Self-efficacy and Depression on Quality of Life in Outpatients with CHF
Effect of Self-efficacy and Depression on Quality of Life in Outpatients with CHF
Effect of Self-efficacy and Depression on Quality of Life in Outpatients with CHF
Heart disease is one of the leading causes of death among people with different racial and ethnic groups all over the world. Heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in our body. Although it is a very serious condition, it doesn’t mean that the heart has stopped beating but it causes people to have difficult time performing their daily activities. About 6.2 million adults in United States have heart failure and 659,000 people die from the heart disease each year which is 1 in every 4 deaths (CDC, 2020). According to CDC guidelines, the total cost of health disease was estimated $363 billion from 2016 to 2017 which includes the cost of health care services, medication and missed days of work from an individual. Likewise, heart failure was mentioned on 379,800 death certificates in 2018 (CDC, 2020). Living with Chronic Heart Failure can be very challenging as many of them report poor quality of life and emotional distress. The PICO question based on the topic of heart failure is, in outpatient (25-50 years old) with chronic heart failure (P), how does self-efficacy and depression (I) influence quality of life (O) compared to having family support (C) over one year(T)?
In research study, participants were recruited through outpatient cardiology clinics at a tertiary hospital in Singapore. Based on the literature review, the study selected six factors (physical and emotional dimensions, depression, self-efficacy, social demographics, length of diagnosis and social support) to identify the predictive factors of health-related quality of life of outpatient with CHF by using multiple linear regression analysis. Among these factors, only depression measured by SF-CDS (ß= 0.637, p<0.001, 95%CI: 2.04-3.01) and self-efficacy assessed by CSS (ß=-0.220, p<0.001,95%CI: -10.70 to -3.23) were significant predictive factors of health-related quality of life for outpatients with CHF accounting for nearly 70% of the variance (Loo et al., 2016). Being able to perform daily living activities increases the sense of living with the illness in the patient. Higher level of self-efficacy like confidence in managing the symptoms and self-care among the participants have reported improved quality of life. Similarly, the patients who don’t have adequate resources to deal with the challenges associated with CHF should also be considered. CHF result in limiting mental health along with the physical symptoms leaving the individual with the feeling of helplessness. Depression and anxiety level were found to negatively influence individual psychosocial wellbeing since CHF patients must bear a burden of having a disease. In this current study, depression was identified as negative predictor of quality of life which is consistent with previous research article. Based on these finding, it is interference that lower self-efficacy and depression predicted poor health related quality of life in outpatients with CHF. This directly correlates the PICO question as low self-efficacy and depression lowers the quality of life compared to having a family support. Such predictor can serve as an indicator for healthcare professionals to provide interventions for potential psychosocial risk of depression during the outpatient visit.
Reliability is mainly about the consistency in measurement within the studies (Grove et al., 2015). In critiquing the reliability of the Loo et al. (2016) article, the author used questionnaires and scale that focuses on the physical and emotional dimension, measures depression, assess patient’s self-confidence and measure positive social support. Firstly, the study uses The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) to measure how CHF has impacted the quality of life grouped into physical and emotional dimension with score ranging from 0 to 105 (Loo et al., 2016). MLWHFQ has very high reliability with a Cronbach’s alpha of 0.95 for the overall scale and 0.94 to 0.95 for the subscales (Loo et al., 2016). Additionally, the study also used short form-cardiac depression scale (SF-CDS) that measures the depressed mood in cardiac patients through 5-item self-rating scale. Lastly, 16-item questionnaire Cardiac Self-Efficacy Scale (CSS) assess the patient’s confidence with controlling symptoms and maintain functions (Loo et al., 2016). The internal consistency of CSS from this study has acceptable Cronbach’s alpha of 0.86 (Loo et al., 2016). The questionnaire was provided to the participants who met the criteria while they waited at the cardiac clinic taking an average time of 20-30 minutes to complete the questionnaires. So, Loo et al. (2016) article was reliable in both its data collection and measurement methods.
Validity is defined with determining “how well the instrument reflects the abstract concept being examined” (Grove et al., 2015). In critiquing the validity of the Loo et al. (2016) article, a cross-sectional, descriptive correlational study design was used to conduct their study. The study looked at how self-efficacy and depression impacts the quality of life of an outpatient with CHF. The scale of depression and self-efficacy was assessed based on SF-CDC and CDD respectively. Higher score in SF-CDC indicates higher levels of depression symptoms whereas higher CDD level indicates better ability to cope with the demanding situation with high confidence (Loo et al., 2016). Hence, Loo et al. (2016) showed validity in its research design and measurement methods.
The research study conducted by Loo et al. (2016) had both weakness and strength that stood out in the studies. A weakness within the study was using a convenience sample of only outpatient with a clinical diagnosis of CHF resulting a very small sample size of 97 participants (Loo et al., 2016). Although the self-reported questionnaires were advantageous in gathering prospective data, response set bias would have maximize the author’s ability to control the biases while administering the forms (Loo et al., 2016). A strength within the study was the use of 6-point Likert scale from 0(no impact) to 5(high impact) to score physical and emotional dimension rather than having to answer the questions on their own (Loo et al., 2016). Likewise, the author was able to create Chinese version of MLWHFQ survey with a Cronbach’s alpha of 0.95 (Loo et al., 2016). Having Cronbach’s alpha close to 1.0 gives the strong consistency and less random error in the survey resulting a strong reliability (Grove et al.,2015).
In the Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adult from American Heart Association website, ACC and AHA collaborated with NHLBI and other professional organizations to publish 4 guidelines based on assessment of CV risk, lifestyle modification, management of obesity in the adults and management of blood cholesterol in the adults (American Heart Association, 2018). These guidelines evaluate and classify the evidence to provide a quality of life by addressing the behavior of self-management of blood pressure in addition to medication adherence. The guidelines also address how certain comorbidities such as CKD, ischemic heart disease, PAD, DM affect the clinical decision-making in hypertension. The risk factors of such comorbidities are common among adults with hypertension and 71% of adults in United States diagnosed with DM have hypertension (American Heart Association, 2018). Correcting the dietary intake, excessive consumption of alcohol, smoking, low fitness level and lifestyle changes with or without pharmacological intervention is an important approach towards managing and preventing hypertension. The second fact is although the writing committee was able to correlate a vast topic on the hypertension to make strong recommendation across broad field of medical condition, significant gap in the knowledge exist (American Heart Association, 2018). Further research in decision-making with patient and their family is needed where evidence doesn’t clearly identify if one treatment is better than another. Lastly, the third fact is although these clinical guidelines manage a large amount of accumulated knowledge related to diagnosis of hypertension, it often causes controversy when comparing recommendation made by different expert (American Heart Association, 2018). The guidelines emphasize how collaborating with patient increases provider’s knowledge on the health outcome and quality of life to improve the achievement of competing health concerns. All these findings are relevant to PICO question and nursing practice because they establish the need for non-pharmacological interventions and lifestyle changes that can help patients improve quality of life.
The systematic review article by Hodson et al. (2019) gives further information on how family caregiver plays a vital role taking care of the patient with Heart Failure and they should be seen one of the important members of the health care team as well. Although it takes time to develop strong base for healthcare professional to work in direct contact with the patient with advance heart failure, the experience of the caregiver can be significantly improved by implementing some minor changes in the clinical practice (Hodson et al., 2019). Studies have shown those who lack the family caregiving support feel overwhelmed by loneliness and lose hope for the future easily demotivating them to perform self-care activities and may cause depression. Additionally, the research has demonstrated caregiver of spouse with unique caregiving experiences compared to children, siblings and parents reporting a lower quality of life, financial burden, and increase risk of depression (Hodson et al., 2019). Caregivers make various sacrifices like spend large amount of time at the home setting which creates a sense of isolation from their surrounding community. Although the caregiver experiences a higher degree of burden while caring for advance heart failure patient, higher self-efficacy indicates improved quality of life in the patient with CHF in the presence of their family caregiver. The article also mentioned that the unique needs of caregivers of those with advance heart failure are not being met and aims to further ascertain the gaps that require further exploration (Hodson et al., 2019). These facts derived from the article is relevant to PICO question and nursing practice because they contribute to improve the current practice working with the caregiver of person with HF.
To summarize, in outpatient (25-50 years old) with chronic heart failure (P), how does self-efficacy and depression (I) influence quality of life (O) compared to having family support (C) over one year(T)? The lower self-efficacy and depression predicted lower quality of life which served as indicator for healthcare professionals to provide tailored interventions (Loo et al., 2016). Many heart failure patients had trouble in self-care and often needed the social support from their family that reports improved quality of life. These results suggest that increasement in self-efficacy have positive effect on the quality of life in people who have CHF by reducing the potential psychosocial risk of depression during the outpatient visit. The findings from this study offered recommendations to future studies for tailoring therapeutic interventions to improve health related quality of life among CHF outpatients (Loo et al., 2016).
References
Centers for Disease Control and Prevention. (2020, September 8). Heart failure. Centers for Disease Control and Prevention. Retrieved October 3, 2021, from https://www.cdc.gov/heartdisease/heart_failure.htm.
Loo, D. W., Jiang, Y., Koh, K. W., Lim, F. P., & Wang, W. (2016). Self-efficacy and depression predicting the health-related quality of life of outpatients with chronic heart failure in Singapore. Applied Nursing Research, 32, 148–155. https://doi.org/10.1016/j.apnr.2016.07.007
Hodson, A. R., Peacock, S., & Holtslander, L. (2019). Family caregiving for persons with Advanced Heart Failure: An Integrative Review. Palliative and Supportive Care, 17(6), 720–734. https://doi.org/10.1017/s1478951519000245
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