Abstract 223: The Role of Confidence in Home Care Workers' Contribution to Heart Failure Patients' Self-care: Testing a Structural Equation Model

Background: Home healthcare workers (HCWs) frequently care for adults with heart failure (HF). Prior studies have found that HCWs promote HF patients’ self-care, but are poorly prepared to do so and lack confidence. Also, how mutuality (the positive quality of the relationship) between HCWs and HF patients contributes to care is unknown. We investigated these issues quantitatively, guided by the Situation-specific Theory of Caregiver Contribution to HF self-care. We hypothesized that HCW preparedness and mutuality influenced HCW contribution to HF self-care maintenance (behaviors to maintain HF stability) and management (response to HF symptoms), with confidence mediating the relationship. Methods: We conducted a cross-sectional survey of English-speaking HCWs employed by 23 home care agencies who cared for a HF patient in the last year in New York, NY. HCWs completed a sociodemographic questionnaire, the Caregiver Preparedness Scale (CPS), the Mutuality Scale (MS), and the Caregiver Contribution to Self-Care of HF Index (CC-SCHFI), which assesses caregiver contribution to self-care maintenance, management, and caregiver confidence. We tested our hypotheses with structural equation modeling (SEM). Mediation analysis was done to test indirect effects. Results: The 317 HCWs had a median age of 50, 94% were women, 44% were Non-Hispanic Black, 79% had ≥ high school education, 71% were foreign-born, and all spoke English. The HCW had a median of 8.5 years of caregiving experience. Overall, HCWs felt prepared for HF caregiving (CPS mean 3.86 [SD: 0.93]) and had moderately positive relationships with patients (MS mean 3.87 [SD: 0.76]). 63% contributed adequately to self-care maintenance, 22% to self-care management, and 44% felt confident with HF caregiving. The tested model fit the data well (CFI=.98; RMSEA=.04) and showed the following significant relationships: mutuality and preparedness covaried (r=.47); preparedness influenced HCW confidence (b=.79); mutuality influenced HCW contribution to self-care maintenance (b=.25); HCWs confidence influenced their contributions to self-care maintenance (b=.22) and management (b=.52). HCWs’ contribution to self-care maintenance influenced their contribution to self-care management (b=.47). Analysis of the indirect effects showed that HCW confidence fully mediated the relationship between preparedness and contributions to self-care maintenance (effect=.17) and management (effect=.41). Conclusions: While HCWs’ preparedness heavily influenced their contribution to HF self-care, HCWs’ confidence, mediated this relationship. Thus, confidence, a modifiable factor, plays a key role in HCWs’ contribution to HF self-care. As this workforce increasingly cares for HF patients, the mechanisms underpinning the relationships among HCWs’ preparedness, mutuality, confidence, and self-care warrant further study.