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

Abstract

Aim: 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. Methods: 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. Results: 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. Conclusions: 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.