Moderating effect of psychosocial factors for dyspnea in Taiwanese and American heart failure patients

Tsuey Yuan Huang, Debra K. Moser, Yeu Sheng Hsieh, Bih Shya Gau, Fu Tuein Chiang, Shiow Li Hwang

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Dyspnea is the most common and distressing symptom of heart failure (HF). Evidence from empirical studies has shown that multiple factors apart from pathophysiological changes may influence this symptom. Purpose: This study explored the moderating effect of psychosocial factors between clinical characteristics and dyspnea in patients with HF. To assess the potential effects of cultural background, this study also compared differences in psychosocial factor moderating effects between HF patients in Taiwan and the United States. Methods: We recruited patients with HF from outpatient clinics in Taiwan and the United States. Data were collected at clinics and research centers. Dyspnea was measured using the modified pulmonary function status and dyspnea questionnaire. Psychosocial factors considered were depression, anxiety, perceived control, and perceived social support. These factors were measured using the Brief Symptom Inventory, Revised Control Attitudes Scale, and Multidimensional Scale of Social Support Scale, respectively. Multiple regressions with interaction effect analysis tested the moderator effects across these two groups. Results: Ninety-seven Taiwanese (mean age = 66.2 ± 12.1 years; 76% male; 28% NYHA [New York Heart Association] II I/IV) and 96 American (mean age = 61.6 ± 11.7 years; 74% male; 42% NYHA III/IV) patients participated. In Taiwanese patients, only perceived social support (B = .08, p = .034) moderated the relationship between clinical variables and dyspnea. In American patients, depression (B = .75, p = .028) and anxiety (B = .85, p = .041) were moderators of the relationship between clinical status and dyspnea severity. Conclusions/Implications for Practice: Depression, anxiety, and perceived social support moderated the relationship of clinical characteristics with dyspnea in Taiwanese and American HF patients, respectively. Attention to these psychosocial factors may improve dyspnea status in HF patients. Symptom management should include a focus on patients' psychological distress and social perspectives.

Original languageEnglish
Pages (from-to)49-58
Number of pages10
JournalJournal of Nursing Research
Issue number1
StatePublished - Mar 2013


  • Cultural difference
  • Dyspnea
  • Heart failure
  • Moderator

ASJC Scopus subject areas

  • General Nursing


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