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Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured
The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.ORCID iD: 0000-0002-1139-9489
The Swedish Red Cross University College, Department of Nursing and Care. Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
Mälardalen University, Academy of Health, Care and Social Welfare, Eskilstuna/Västerås.
Karolinska Institutet Department of Clinical Sciences Danderyd Hospital.
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2015 (English)In: Cardiology Research, ISSN 1923-2829, E-ISSN 1923-2837, Vol. 6, no 2, 239-248 p.Article in journal (Refereed) Published
Abstract [en]

Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF.

Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL.

Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF.

Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.

Place, publisher, year, edition, pages
2015. Vol. 6, no 2, 239-248 p.
Keyword [en]
Heart failure; Factor analysis; Statistical; Adaption; Psychological; Quality of life; Self-report
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:rkh:diva-1840DOI: 10.14740/cr385wOAI: oai:DiVA.org:rkh-1840DiVA: diva2:811753
Available from: 2015-05-13 Created: 2015-05-13 Last updated: 2015-09-07Bibliographically approved
In thesis
1. Coping and emotional well-being in patients with chronic heart failure
Open this publication in new window or tab >>Coping and emotional well-being in patients with chronic heart failure
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic heart failure (CHF) is a serious illness, with a profound impact on the patient. Poor health-related quality of life (HRQoL) as well as anxiety and depression are prevalent in CHF and predict mortality and rehospitalization, yet, psychosocial factors are infrequently treated and cared for.

Aim: To gather scientific evidence on illness perception and coping strategies to predict emotional well-being in patients with CHF and to establish a measurement model of coping strategies. Furthermore, to evaluate a nurse-led psychoeducational intervention, Coping Effectiveness Training (CET) adapted for patients with CHF.

Methods: Studies I-III were cross sectional. Study IV was a randomized controlled trial aimed to improve emotional well-being (one-year follow-up). All studies used patient reported outcome measures and clinical data via medical journals.

Results: Younger age and male gender were associated with higher levels of alcohol usage and/or drugs to cope, p < 0.01. Poor sense of coherence was associated with maladaptive coping (I). A four factorial model of Brief COPE displayed the best psychometric properties (II). Avoidant coping influenced negative affect (NA) (I), worse HRQoL (II) and greater anxiety and depression (III). CET (IV) improved personal control in the intervention group (IG) compared to the control group (CG), p = 0.036. Improved scores for the IG were detected in emotional well-being and HRQoL, p = ns. The IG demonstrated reduced NA, p = 0.022, excluding cases with clinical anxiety and depression. Time to cardiovascular readmission or death was non-significantly lower in the IG vs the CG (Hazard ratio 0.58 [0.29-1.18]) adjusted p = 0.135.

Conclusions: Personal resources seemed to influence the coping strategies used by patients with CHF. Avoidant coping had an adverse influence on emotional wellbeing and illness perception in CHF. The perceived sense of control and illness burden were of importance for emotional well-being. A CET intervention for patients with CHF increased sense of control over the illness. CET also reduced NA in patients with no or mild symptoms of anxiety and depression.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2015. 82 p.
Keyword
Heart failure; Coping; Illness perception; Emotional well-being; Quality of life; Intervention; Randomized controlled trial
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:rkh:diva-1899 (URN)978-91-7676-001-7 (ISBN)
Public defence
2015-09-11, Sal Henry Dunant, Teknikringen 1, Stockholm, 09:00 (Swedish)
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Supervisors
Available from: 2015-09-07 Created: 2015-09-03 Last updated: 2015-09-07Bibliographically approved

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