Associations of resilience and perceived social support with self-care among patients with heart failure: A cross-sectional study
https://doi.org/10.52235/lp.v7i4.996
Keywords:
perceived social support, heart failure, resilience, self-careAbstract
Background: Effective heart failure (HF) management requires comprehensive self-care. In multicultural societies, self-care is shaped by internal psychological resilience and external social support that influence treatment decisions.
Objective: This study aimed to examine the associations of resilience and perceived social support with self-care among patients with heart failure.
Methods: This single-centre cross-sectional study was reported in accordance with the STROBE statement. Participants were enrolled using consecutive sampling at an outpatient cardiology clinic in Subang, West Java, Indonesia. Eligible participants were adults with a physician-confirmed diagnosis of HF (NYHA I–III) documented in the medical records, with a diagnosis of at least six months’ duration. Resilience, perceived social support and self-care were measured with the 10-item Connor–Davidson Resilience Scale, the Medical Outcomes Study Social Support Survey (MOS-SSS) and the Self-Care of Heart Failure Index (SCHFI) v7.2, respectively. Unadjusted associations were analysed using Spearman’s rank correlation with 95% confidence intervals.
Results: Of 40 patients screened, 36 were analysed. The mean age was 65.17 ± 7.07 years, and 20 (55.6%) were male. The mean resilience score was 36.03 ± 3.96, and the mean perceived social support score was 87.64 ± 4.07. Resilience showed a moderate positive correlation with self-care (ρ = 0.545, 95% CI 0.254–0.745, p = 0.001) and a moderate positive correlation with perceived social support (ρ = 0.513, 95% CI 0.212–0.725, p = 0.001).
Conclusion: Resilience and perceived social support were each positively associated with self-care in this sample of patients with heart failure; the association was moderate for resilience and moderate for perceived social support. Because the design was cross-sectional and the analyses were unadjusted and based on a small single-centre sample, these findings are hypothesis-generating and do not show that either factor drives self-care. Whether assessing both factors adds value to routine self-care education.
Downloads
References
Babygeetha, A., & Devineni, D. (2024). Social support and adherence to self-care behavior among patients with coronary heart disease and heart failure: A systematic review. Europe’s Journal of Psychology, 20(1), 63–77. https://doi.org/10.5964/ejop.12131
Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor–Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress, 20(6), 1019–1028. https://doi.org/10.1002/jts.20271
Cené, C. W., Haymore, L. B., Dolan-Soto, D., Lin, F.-C., Pignone, M., DeWalt, D. A., Wu, J.-R., Jones, C. D., & Corbie-Smith, G. (2013). Self-care confidence mediates the relationship between perceived social support and self-care maintenance in adults with heart failure. Journal of Cardiac Failure, 19(3), 202–210. https://doi.org/10.1016/j.cardfail.2013.01.009
Chen, C., Sun, X., Zhang, Y., Xie, H., Kou, J., & Zhang, H. (2025). Fear of progression and quality of life in patients with heart failure: A cross-sectional study on the multiple mediation of psychological distress and resilience. BMC Nursing, 24(1). https://doi.org/10.1186/s12912-025-02688-8
Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor–Davidson Resilience Scale (CD-RISC). Depression and Anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113
Cuschieri, S. (2019). The STROBE guidelines. Saudi Journal of Anaesthesia, 13(Suppl 1), S31–S34. https://doi.org/10.4103/sja.SJA_543_18
D’Souza, P. J. J., Lewis, M. S., Paramasivam, G., Noronha, J. A., Kusumavathi, P., Devasia, T., & George, L. S. (2025). Factors associated with self-care behavior among heart failure patients in India: A systematic review. Journal of Education and Health Promotion, 14(1). https://doi.org/10.4103/jehp.jehp_1778_24
Fivecoat, H. C., Sayers, S. L., & Riegel, B. (2018). Social support predicts self-care confidence in patients with heart failure. European Journal of Cardiovascular Nursing, 17(7), 598–604. https://doi.org/10.1177/1474515118762800
Graven, L. J., Gordon, G., Keltner, J. G., Abbott, L., & Bahorski, J. (2018). Efficacy of a social support and problem-solving intervention on heart failure self-care: A pilot study. Patient Education and Counseling, 101(2), 266–275. https://doi.org/10.1016/j.pec.2017.09.008
Huang, J., Liu, X., Wang, D., Luan, X., Yao, W., & Chen, Z. (2025). Perceived social support and psychological resilience as mediators between social frailty and the frailty of older patients with heart failure: a cross-sectional study. BioPsychoSocial Medicine, 19(1), 25. https://doi.org/10.1186/s13030-025-00345-9
Jaarsma, T., Hill, L., Bayes-Genis, A., La Rocca, H.-P. B., Castiello, T., Čelutkienė, J., Marques-Sule, E., Plymen, C. M., Piper, S. E., Riegel, B., Rutten, F. H., Ben Gal, T., Bauersachs, J., Coats, A. J. S., Chioncel, O., Lopatin, Y., Lund, L. H., Lainscak, M., Moura, B., … Strömberg, A. (2021). Self-care of heart failure patients: Practical management recommendations from the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 23(1), 157–174. https://doi.org/10.1002/ejhf.2008
Kamath, D., Bhuvana, K., Dhiraj, R., Xavier, D., Varghese, K., Salazar, L., Granger, C., Pais, P., & Granger, B. (2020). Patient and caregiver reported facilitators of self-care among patients with chronic heart failure: Report from a formative qualitative study. Wellcome Open Research, 5, 10. https://doi.org/10.12688/wellcomeopenres.15485.1
Kamath, D. Y., Bhuvana, K. B., Salazar, L. J., Varghese, K., Kamath, A., Idiculla, J., Pais, P., Kulkarni, S., Granger, B. B., & Xavier, D. (2021). A qualitative, grounded theory exploration of the determinants of self-care behavior among Indian patients with a lived experience of chronic heart failure. PLOS ONE, 16(1), e0245659. https://doi.org/10.1371/journal.pone.0245659
Li, M., Cheng, L., & Jiang, Y. (2024). The chain mediating role of rumination and psychological resilience in symptom burden and kinesiophobia in patients with chronic heart failure. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1474715
Megiati, H. M., Grisante, D. L., D’Agostino, F., Santos, V. B., & Lopes, C. T. (2022). Relationship between perceived social support and self-care of patients with heart failure. Acta Paulista de Enfermagem, 35. https://doi.org/10.37689/acta-ape/2022AO0129666
Meraz, R., McGee, J., Caldwell, E. P., Ke, W., & Osteen, K. (2023). The impact of resilience, health literacy, and social support on medication adherence and self-care among adults with heart failure. Journal of Cardiovascular Nursing, 38(5), 415–424. https://doi.org/10.1097/JCN.0000000000000948
Niriayo, Y. L., Yemane, B., Asgedom, S. W., Teklay, G., & Gidey, K. (2024). Prevalence and predictors of poor self-care behaviors in patients with chronic heart failure. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-52611-5
Noviana, C. M., & Zahra, A. N. (2022). Social support and self-management among end-stage renal disease patients undergoing hemodialysis in Indonesia. Journal of Public Health Research, 11(2). https://doi.org/10.4081/jphr.2021.2733
Perwitasari, P., & Wulandari, R. P. (2024). Validity and reliability of Connor–Davidson Resilience Scale (CD-RISC) 10 items on pregnant women. International Journal of Midwifery Research, 4(1). https://doi.org/10.47710/ijmr.v4i1.68
Philip, A., Shastry, C. S., Unnikrishnan, M. K., & Utagi, B. (2024). Empowering selfcare through patient education in heart failure patients: A multimodal approach comprising of PPILs, videos, and personalized advice. Journal of Education and Health Promotion, 13(1). https://doi.org/10.4103/jehp.jehp_1797_23
Pitora, T., Pahria, T., & Sari, E. A. (2022). Analysis of factors related to self-care in chronic heart failure patients in Indonesian. Media Keperawatan Indonesia, 5(4), 309. https://doi.org/10.26714/mki.5.4.2022.309-316
Riegel, B., Barbaranelli, C., Carlson, B., Sethares, K. A., Daus, M., Moser, D. K., Miller, J., Osokpo, O. H., Lee, S., Brown, S., & Vellone, E. (2019). Psychometric testing of the revised Self-Care of Heart Failure Index. Journal of Cardiovascular Nursing, 34(2), 183–192. https://doi.org/10.1097/JCN.0000000000000543
Sedlar, N., Lainscak, M., & Farkas, J. (2021). Self-care perception and behaviour in patients with heart failure: A qualitative and quantitative study. ESC Heart Failure, 8(3), 2079–2088. https://doi.org/10.1002/ehf2.13287
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science & Medicine, 32(6), 705–714. https://doi.org/10.1016/0277-9536(91)90150-B
Siregar, L. (2024). Analysis of factors related to self-care management in heart failure patients: Scoping review. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 9(2). https://doi.org/10.30604/jika.v9i2.2592
Świątoniowska-Lonc, N., Polański, J., Pilarczyk-Wróblewska, I., & Jankowska-Polańska, B. (2021). The Revised Self-Care of Heart Failure Index — a new tool for assessing the self-care of Polish patients with heart failure. Kardiologia Polska, 79(7–8), 841–847. https://doi.org/10.33963/KP.a2021.0009
van Rijn, M. M., Jaarsma, T., de Man-van Ginkel, J. M., & Weldam, S. W. M. (2023). Association between self-care and resilience. Journal of Cardiovascular Nursing, 38(2), E70–E77. https://doi.org/10.1097/JCN.0000000000000908
Wang, X., & Cheng, Z. (2020). Cross-sectional studies. Chest, 158(1), S65–S71. https://doi.org/10.1016/j.chest.2020.03.012
Wideqvist, M., Cui, X., Magnusson, C., Schaufelberger, M., & Fu, M. (2021). Hospital readmissions of patients with heart failure from real world: Timing and associated risk factors. ESC Heart Failure, 8(2), 1388–1397. https://doi.org/10.1002/ehf2.13221
Yamanaka, S., Nochioka, K., Hayashi, H., Shiroto, T., Takahashi, J., Miyata, S., Yasuda, S., & Shimokawa, H. (2024). Age-stratified profiles and outcomes of patients with heart failure with preserved ejection fraction. ESC Heart Failure, 11(4), 2223–2233. https://doi.org/10.1002/ehf2.14798
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Tobi Pitora, Firmansyah Firmansyah
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
