Background 

Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF.

Objective 

The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF.

Method 

This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale–Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively.

Results 

Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08).

Conclusion 

In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.

中文翻译：

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B期心力衰竭患者的谢意，自我效能和药物依从性的结构方程模型

背景 

持续的自我护理会减慢心力衰竭（HF）的进程。感恩，一种欣赏生活中积极方面的习惯，可能会影响自我效能感，而自我效能感反过来又可以改善自我护理。但是，对于HF中感恩，自我效能和药物依从性之间的关系知之甚少。

目的 

这项研究的目的是测试一种模型，以确定无症状HF患者的自我效能是否能介导感恩与药物依从性之间的关系。

方法 

这是来自前瞻性观察研究的数据的辅助分析。使用结构方程模型分析数据，以检查153例HF患者的感恩，心脏特异性自我效能和药物依从性之间的关联。分别使用Gratitude Questionnaire-6，心脏自我效能量表-维持功能子量表和Morisky药物依从量表评估了感恩，自我效能和药物依从性。

结果 

患者平均（SD）年龄为66（11）岁，其中95％的参与者为男性。患者主要是白人（79％），黑人（12％）或亚裔（6％）。感恩通过自我效能对药物依从性产生间接影响（b = 0.16；P <.05）。感恩与自我效能感呈正相关（b = 0.50；P <.05），自我效能感与药物依从性呈正相关（b = 0.31；P<.05）。模型拟合是可接受的（比较拟合指数= 0.92，塔克-刘易斯指数= 0.90，近似均方根误差= 0.08）。

结论 

在这项研究中，我们发现证据表明自我效能感是一种机制，通过这种机制，感激与无症状HF患者的用药依从性有关，从而提出了一种非药理性改善自我护理的方法。未来的工作将研究感恩干预是否可以改善自我保健。