heart failure, knowledge, patient activation, rural health, self-management behavior



  1. Young, Lufei PhD, RN, APRN-NP
  2. Kupzyk, Kevin PhD
  3. Barnason, Susan PhD


Background: Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear.


Objective: The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients.


Methods: A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors.


Results: Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P < .001; [beta] = .48, P = .001). However, self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model ([beta] = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors ([beta] = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high ([beta] = .27, P = .27) or low ([beta] = .27, P = .25) levels of SM support.


Conclusions: Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients' SM confidence.