Date Published: June 4, 2019
Publisher: Public Library of Science
Author(s): Mahdi Shamali, Hanne Konradsen, Lara Stas, Birte Østergaard, Brita Roy.
Social support, family functioning and family health are essential elements in the treatment of heart failure, yet most heart failure studies focus on the pharmacological interventions. This study aimed to examine whether perceived social support from nurses is associated with better family functioning of patients with heart failure and their nearest relatives and to examine whether family health mediates this relationship.
A sample of 312 patients with heart failure and 312 of their nearest relatives were included in the study. The Family Functioning, Health and Social Support questionnaire was used to collect the data. Dyadic data were analysed by the Actor–Partner Interdependence Mediation Model with distinguishable dyads using structural equation modelling. Patients and nearest relatives who perceived more social support had a higher level of family health and functioned better within the family. One partner effect was found, indicating that the higher the level of family health of the nearest relative, the better the family functioning of the patient (p <0.001). Family health partially (in the patient) and completely (in the nearest relative) mediated the association between social support and family functioning. This study indicated that patients with heart failure and their nearest relatives who perceived more social support from nurses were more likely to have high level of family health and function better within the family. The interdependent relationships found in our study highlight a dyadic and family-oriented approach to improve family functioning in patients with heart failure.
Heart failure (HF), a major clinical and public health problem, is becoming a leading cause of disability and death among older adults [1–3]. In developed countries, 1–2% of the general population has HF , and the 5-year mortality rate among patients with HF is similar to that of many cancers . Rehospitalisation is common among patients with HF, with more than 50% readmission within 6 months of discharge . HF is a burden on health care services due to the significant mortality, morbidity, hospitalizations and health care expenditures associated with it [1, 3, 4]. HF can also be perceived as a burden on the family due to disagreement between patients and their family members on illness management [6, 7].
In this dyadic analysis of a sample of patients with HF and their nearest relatives, 5 actor effects (of 6 possible), 1 partner effect (of 6 possible), 2 indirect actor effects (of 2 possible) and 1 indirect partner effect (of 4 possible) were identified. Similarly, previous studies using dyadic analysis in a cardiovascular context indicated a larger number of actor effects than partner effects [8, 20, 29].
Based on the results of this study, patients with HF and their nearest relatives who had more perceived social support tended to have higher levels of family health and family functioning. One possible implication of this is that health care providers should consider incorporating social support for HF patients and their relatives to enhance family health and family functioning. Family functioning is important in modifying the lifestyle of the patient and family in response to an illness . Hence, by improving family functioning, patients with HF and their families can better cope with the disease. Family functioning is also a nonpharmacological approach, by promoting self-care behaviours and medication adherence, to improve the outcomes in patients with HF . Interventional studies are needed to better address the association between social support and family functioning.
The major strength of this study is the analytic method, which used the APIMeM to detect actor, partner and mediating effects. The inclusion of both patients and their nearest relatives was another strength of this study. However, the findings of this study must be considered with some caveats. First, this was a cross-sectional study without a control group and thus did not allow any inferences of causality in these relationships. Second, our findings may reflect a selection bias as patients and their relatives experiencing low levels of family health and family functioning may have had less motivation to participate in the study. Third, some patients and their relatives might have special challenges in their lives (not related to HF) that might impact their family health and family functioning. However, we did not assess such challenges. Finally, the results of our study can only be applied to the type of patient and nearest relative we studied. In our study, most of dyads were married, most of nearest relatives were spouses, and most of patients were newly diagnosed with HF (median of 1 month) and had mild HF symptoms (NYHA Class II). Therefore, our results should be generalized with caution to other types of patients and their nearest relatives.
This study indicated that patients with HF and their nearest relatives who perceived more social support from nurses were more likely to have a high level of family health and function better within the family. An interdependent relationship between patients with HF and their nearest relatives (dyadic effect) was found in this study, where a greater amount of perceived social support in nearest relatives was related to better family functioning in patients. Based on these findings, patients with HF will possibly benefit from dyad- and family-focused approaches that include both the patient and his/her relatives to improve family health and family functioning. Family health partially (in the patient) and completely (in the nearest relative) mediated the association between social support and family functioning. Research is needed to explore this mediational association.