Family cohesion and adaptability in heart failure: an APIMeM analysis of symptom perception and spousal caregiving on patient self-care.

OBJECTIVE

To examine the actor-partner interdependence mediation effect of efamily cohesion and adaptability on self-care ability in patients with chronic heart failure (CHF) and their spouses, mediated through symptom perception and caregiving contribution.

METHODS

A cross-sectional survey was conducted among 212 CHF inpatients and their spouses from Rugao Hospital of Traditional Chinese Medicine, Nantong. Core variables were assessed using: Family Adaptability and Cohesion Scale (FACES-II), Heart Failure Somatic Perception Scale (HFSPS), European Heart Failure Self-Care Behavior Scale for Caregivers (EHFScBS-C), Self-Care of Heart Failure Index (SCHFI). Actor-Partner Interdependence Mediation Model (APIMeM) was employed to analyze actor effects and partner effects.

RESULTS

The family function scores of CHF patients and their spouses were (102.36 ± 18.24) and (98.75 ± 16.83) respectively. The total score of HFSPS for patients was (52.71 ± 12.38), and the total score of EHFScBS-C for spouses was (64.18 ± 14.79). The total score of SCHFI for patients was (155.73 ± 43.30), among which the management dimension was the weakest with a score of (48.67 ± 13.76). In the subject effect analysis, the direct effect of family function on self-care ability accounted for 38.5%, the indirect path through symptom perception accounted for 35.3%, and the indirect path through care contribution accounted for 26.2%. In the object effect analysis, the direct effect of the spouse's family function on the patient's self-care ability accounted for 40.0%, the indirect path through the patient's symptom perception accounted for 32.3%, and the indirect path through the spouse's care contribution accounted for 27.7%.

CONCLUSION

Family cohesion and adaptability are associated with lower levels of symptom burden and greater spousal care contributions, and are both linked to better self-care ability in patients with CHF. Clinical interventions should consider the patient-spouse dyad as a whole. By improving family adaptability and providing targeted support for spouses in managing daily behaviors, patient self-care ability can be enhanced.