BACKGROUND The burden of heart failure (HF) is unequally distributed among population groups. Few study authors have described social determinants of health (SDoH) enabling/impeding self-care. AIM The aim of this study was to explore the relationship between SDoH and self-care in patients with HF. METHODS Using a convergent mixed-methods design, we assessed SDoH and self-care in 104 patients with HF using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and the Self-Care of HF Index v7.2 with self-care maintenance, symptom perception, and self-care management scales. Multiple regression was used to assess the relationship between SDoH and self-care. One-on-one in-depth interviews were conducted in patients with poor (standardized score ≤ 60, n = 17) or excellent (standardized score ≥ 80, n = 20) self-care maintenance. Quantitative and qualitative results were integrated. RESULTS Participants were predominantly male (57.7%), with a mean age of 62.4 ± 11.6 years, with health insurance (91.4%) and some college education (62%). Half were White (50%), many were married (43%), and most reported adequate income (53%). The money and resources core domain of PRAPARE significantly predicted self-care maintenance ( P = .019), and symptom perception ( P = .049) trended significantly after adjusting for other PRAPARE core domains (personal characteristics, family and home, and social and emotional health) and comorbidity. Participants discussed social connectedness, health insurance coverage, individual upbringing, and personal experiences as facilitators of self-care behavior. CONCLUSION Several SDoH influence HF self-care. Patient-specific interventions that address the broader effects of these factors may promote self-care in patients with HF.

中文翻译：

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心力衰竭成人社会决定因素和自我护理的混合方法研究。

背景技术心力衰竭（HF）的负担在人群中分布不均。很少有研究作者描述了促进/阻碍自我保健的健康社会决定因素 (SDoH)。目的本研究的目的是探讨心力衰竭患者SDoH与自我护理之间的关系。方法 采用聚合混合方法设计，我们使用患者资产、风险和经历的应对和评估方案 (PRAPARE) 以及心力衰竭指数 v7 的自我护理来评估 104 名心力衰竭患者的 SDoH 和自我护理。 2 具有自我护理维护、症状感知和自我护理管理量表。使用多元回归来评估 SDoH 和自我保健之间的关系。对自我护理维持能力较差（标准化得分≤60，n = 17）或优秀（标准化得分≥80，n = 20）的患者进行一对一的深度访谈。定量和定性结果被整合。结果 参与者主要为男性 (57.7%)，平均年龄为 62.4 ± 11.6 岁，拥有健康保险 (91.4%) 和受过大学教育 (62%)。一半是白人（50%），许多人已婚（43%），大多数人报告有足够的收入（53%）。PRAPARE 的金钱和资源核心领域显着预测了自我护理维持 (P = .019)，并且在调整其他 PRAPARE 核心领域（个人特征、家庭和社会和家庭）后，症状感知 (P = .049) 呈显着趋势。情绪健康）和合并症。参与者讨论了社会联系、健康保险覆盖范围、个人成长经历以及作为自我保健行为促进因素的个人经历。结论 一些 SDoH 会影响心力衰竭的自我护理。针对这些因素的更广泛影响的针对患者的干预措施可能会促进心力衰竭患者的自我护理。