Psychosocial, Clinical, and Knowledge-Based Factors Associated with Self-Care in Heart Failure: A Cross-Sectional...

This study examined cross-sectional associations between sociodemographic, clinical, behavioral, knowledge-based, and psychological factors and three behavioral scales of heart failure (HF) self-care: Maintenance, Symptom Perception, and Management. Self-Care Confidence was examined as a separate 10-item outcome.

This cross-sectional study recruited 516 consecutive adults with confirmed HF at two tertiary-care HF clinics in northern Jordan between May and November 2025. Self-care was assessed using the SCHFI v7.2, HF knowledge using the AHFKT, and anxiety and depression using the HADS. Separate multivariable ordinary least-squares regression models estimated adjusted associations with Maintenance, Symptom Perception, Management, and Confidence. Association-rule mining was used to identify descriptive co-occurrence profiles.

Median SCHFI scores were 50.00 for Maintenance, 43.48 for Symptom Perception, and 51.52 for Management. All four regression models included 516 participants and showed limited explanatory performance (adjusted R² = 0.076-0.127). Each 10-percentage-point increase in the AHFKT percentage-correct score was associated with higher Maintenance (unstandardized coefficient B = 2.02, 95% CI 0.50-3.54), Symptom Perception (B = 2.26, 95% CI 0.78-3.73), and Management (B = 3.81, 95% CI 2.32-5.30). HADS depression was inversely associated with Maintenance (B = -0.94, 95% CI -1.57 to -0.31), Symptom Perception (B = -1.47, 95% CI -2.10 to -0.83), and Management (B = -1.09, 95% CI -1.70 to -0.48). HADS anxiety was positively associated with Symptom Perception (B = 1.37, 95% CI 0.74-2.00) and Management (B = 0.92, 95% CI 0.33-1.51). Elementary and secondary education were associated with lower Maintenance scores. Current smoking (B = -6.69, 95% CI -10.78 to -2.60) and no prior HF admission (B = -4.32, 95% CI -8.21 to -0.42) were separately associated with lower Symptom Perception. Association-rule mining retained 10 exploratory co-occurrence profiles; the highest-lift profile involved male sex, sleeping difficulty, and an HF knowledge score from 50% to <60% for Management scores < 70 (50/51 participants; confidence = 98.0%; lift = 1.25). For the separate Confidence outcome, no profiles met the same final criteria.

Most participants had scores below 70 across the three behavioral scales. Higher HF knowledge was associated with higher scores across self-care maintenance, symptom perception, and self-care management, and higher HADS depression was associated with lower self-care confidence, whereas HADS anxiety was positively associated with self-care confidence; education, smoking, and prior HF admission showed further scale-specific cross-sectional associations.