3005 — Levels of Family Autonomy-Support Climate and Self-care of Veterans with Heart Failure and Diabetes

Sayers SL (Philadelphia VAMC/University of Pennsylvania), Mavandadi S (Philadelphia VAMC/University of Pennsylvania), Jackson-Malik P (Philadelphia VAMC), Stern J (Philadelphia VAMC), Murphy J (Philadelphia VAMC), Wiener MG (Philadelphia VAMC/University of Pennsylvania)

Objectives:
The ways in which family members attempt to support chronically ill patients, while also supporting patients’ autonomy, may have an impact on patients’ self-care. We tested the type of support offered by family members was associated with self-care in veterans with chronic heart failure (CHF), and patients with diabetes mellitus (DM).

Methods:
Outpatients with CHF (N=77, age > 60, 84.3% male) and DM (N=86, age > 60, 70.6% male) from the Philadelphia VA Medical Center were assessed with the SF-12 and the FCQ. Veterans with CHF also were assessed with the Self-care of Heart Failure Index (SCHFI) and veterans with DM were assessed with the Summary of Diabetes Self-care Activities Measure (SDSAM). The FCQ-Autonomy-Support subscale is similar to existing measures of autonomy-support, and the new FCQ-Coercive subscale assesses emotionally coercive strategies to influence patients’ health behaviors (“My family member nags me about taking my medication”). The SCHFI assesses maintenance self-care, management of HF symptoms, and self-care confidence. Most participants had significantly lower SF-12 physical health scores than nonpatient samples (M=35.2, SD=10.1).

Results:
CHF patients with higher autonomy-support scores had significantly better maintenance self-care, r=.23, p < .05, and better mental health, r=.34, p < .05. CHF patients who reported higher levels of coercive support had significantly lower self-care confidence, r=-.21, p < .05. DM patients with higher autonomy-support had higher overall self-care, diet, exercise, and mental health (.20 < r’s < .25, p’s < .05). Patients with higher levels of coercive support had poorer mental health, r=-.32, p < .05.

Implications:
The ways that family members try to help, support, and influence chronically ill patients regarding their self-care may have significant impact on the self-care and mental health of chronically ill patients.

Impacts:
There is significant opportunity to involve family members in learning optimal ways to support and influence veterans' self-care. In turn, it may be possible to improve the quality of life of veterans with chronic illnesses such as CHF and DM.