A Mixed-Methods Study of Social Determinants and Self-care in Adults With Heart Failure.
Foster Osei Baah, Bridgette M Brawner, Anne M Teitelman and 2 others
PMID 37816083WHAT IT FOUND
Adults with heart failure who reported more money and resource problems had better self-care maintenance and symptom perception scores.
Interviews tied self-care to insurance, upbringing, and social connections.
Key findings
01Only the money and resources PRAPARE domain was significantly correlated with self-care maintenance and symptom perception.
02Participants described social connectedness, individual upbringing and personal experiences, and health insurance coverage as factors influencing self-care choices.
03The quantitative and qualitative findings were consistent for money and resources and self-care maintenance, but discordant for social connectedness.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was cross-sectional, so it cannot show that social determinants caused differences in self-care or that self-care caused differences in social determinants. It enrolled only English-speaking adults in urban northeastern United States settings, so results may not apply to rural areas, other regions, or people who do not speak English. Recruitment stopped at 104 participants because of COVID-19, slightly below the planned 108. The PRAPARE had poor internal consistency in this sample (Cronbach's alpha 0.58), and it did not capture racism, insurance quality, or overall incarceration history. Qualitative interviews did not seek saturation, so the themes describe the experiences of the selected extreme-case participants.
Declared interests
No conflicts of interest were declared.
The easy way to misread this
Do not treat these findings as evidence that assessing social determinants will improve heart failure self-care. The study measured associations and experiences at one point; it did not test an intervention.