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African Americans, heart failure, moderation, race, self-care, social support



  1. Cousin, Lakeshia PhD, APRN, AGPCNP-BC
  2. Bugajski, Andrew PhD, RN
  3. Buck, Harleah PhD, RN, FPCN, FAHA, FAAN
  4. Lennie, Terry PhD, RN, FAHA, FAAN
  5. Chung, Misook Lee PhD, RN, FAHA, FAAN
  6. Moser, Debra K. PhD, RN, FAAN, FAHA


Background: African Americans are at the highest risk of developing heart failure (HF) compared with other races and are hospitalized at 7 to 8 times the rate of Whites. Poor overall self-care, low self-care confidence, and lower levels of perceived social support are factors related to increased risk for hospitalizations in HF. Yet, limited evidence is available regarding the factors that may differentially impact self-care confidence by race in patients with HF.


Objective: The aim of this study was to examine to what extent race moderates the relationship between perceived social support and self-care confidence.


Method: This is a secondary analysis of cross-sectional data from African American and White patients with HF in North America (n = 429). Patients completed the Multidimensional Scale of Perceived Social Support and the Self-Care Confidence Scale of the Self-Care of Heart Failure Index. A moderation analysis was conducted using hierarchal linear regression.


Results: Sample mean age was 60.8 +/- 11.5 years, 22.4% were African American, and 54.7% were in New York Heart Association class I or II. Moderation analyses yielded a significant interaction of perceived social support and race, showing White patients, not African Americans, have significantly different self-care confidence scores depending on level of social support: White, b = 0.224, 95% confidence interval [0.046-0.094], t = 5.65, and P < .001; African American, b = -0.776, 95% confidence interval [-0.049 to 0.060], t = 0.212, and P = .832.


Conclusions: Our findings show a variable effect of perceived social support on self-care confidence as a function of race, suggesting the need for further research to develop and test interventions tailored to race and levels of social support in HF.