Mediation by Fatalism of the Association Between Symptom Burden and Self-care Management in Patients With Heart Failure

Background: Clinicians and researchers often assume that symptom burden is associated with self-care management (SCM) in patients with heart failure (HF). However, that association is often not borne out in simple regression analyses and may be because another variable mediates the association. Fatalism is an appropriate candidate for mediation and is the belief that circumstances are predetermined without opportunity for control by individuals. Objective: Our objective was to determine whether fatalism mediated the relationship of symptom burden with SCM among adults with HF. Methods: We conducted a secondary analysis (N = 95) from a clinical trial. We used Self-care of HF Index to measure SCM, the Memorial Symptom Assessment Scale-HF for symptom burden, and the Cardiovascular Disease Fatalism Instrument to measure fatalism. We used the PROCESS macro to evaluate mediation. Results: Symptom burden was not directly associated with SCM (effect coefficient [C'] = 0.0805; 95% confidence interval, −0.048 to 0.209; P = . 217). There was, however, an indirect pathway between symptom burden and SCM through fatalism (ab = −0.040; 95% confidence interval, −0.097 to −0.002). Those with higher symptom burden were more fatalistic (a = 0.004, P = .015), and greater fatalism was associated with worse SCM (b = −9.132, P = .007). Conclusion: Symptom burden, not directly associated with SCM, is associated through the mediator of fatalism. Interventions to improve SCM should include strategies to mitigate fatalistic views. Self-care management interventions should focus on promoting internal locus of control or increasing perceptions of perceived control to decrease fatalism and improve engagement in self-care.