Multiple Comorbid Conditions Challenge Heart Failure Self-Care by Decreasing Self-Efficacy

Document Type


Publication Date



comorbidity, chronicity, heart failure, mixed methods, self-care, self-efficacy

Digital Object Identifier (DOI)



Background: Most heart failure patients have multiple comorbidities.

Objective: This study aims to test the moderating effect of comorbidity on the relationship between self-efficacy and self-care in adults with heart failure.

Methods: Secondary analysis of four mixed methods studies (n = 114) was done. Self-care and self-efficacy were measured using the Self-Care of Heart Failure Index. Comorbidity was measured with the Charlson Comorbidity Index. Parametric statistics were used to examine the relationships among self-efficacy, self-care, and the moderating influence of comorbidity. Qualitative data yielded themes about self-efficacy in self-care and explained the influence of comorbidity on self-care.

Results: Most (79%) reported two or more comorbidities. There was a significant relationship between self-care and the number of comorbidities (r = −.25; p = .03). There were significant differences in self-care by comorbidity level (self-care maintenance, F[1, 112], 5.96, p = .019, and self-care management, F[1, 72], 4.66, p = .034). Using moderator analysis of the effect of comorbidity on self-efficacy and self-care, a significant effect was found only in self-care maintenance among those who had moderate levels of comorbidity (b = .620, p = .022, Fchange df[6,48], 5.61, p = .022). In the qualitative data, self-efficacy emerged as an important variable influencing self-care by shaping how individuals prioritized and integrated multiple and often competing self-care instructions.

Discussion: Comorbidity influences the relationship between self-efficacy and self-care maintenance, but only when levels of comorbidity are moderately high. Methods of improving self-efficacy may improve self-care in those with multiple comorbidities.

Was this content written or created while at USF?


Citation / Publisher Attribution

Nursing Research, v. 62, issue 1, p. 2-9