Dyadic effects of family resilience and mutuality on self-care in chronic heart failure patients and caregivers: an Actor-Partner Interdependence Mediation Model

Self-care and caregivers' contribution to self-care are vital for chronic heart failure (CHF) patients. Family resilience and mutuality are known protective factors for self-care. However, little is known about how family resilience and mutuality contribute to self-care among heart failure patient-caregiver dyads. This study aims to examine actor and partner effects of family resilience on self-care through mutuality among CHF patients and caregiver dyads. In the cross-sectional study, 220 CHF patient-caregiver dyads (n = 440 participants) were enrolled. Family resilience, mutuality, self-care, and self-care contribution to CHF were assessed by self-report questionnaires. The Actor-Partner Interdependence Mediation Model analysis was used to identify the direct and indirect effects of family resilience on self-care through mutuality in CHF patient-caregiver dyads. Actor effects showed that caregivers' family resilience had a direct effect on their own self-care contribution [direct actor effect, B = 0.385; 95% confidence interval (CI), 0.263-0.506]. Caregivers' mutuality (indirect actor effect, B = 0.057; 95% CI, 0.004-0.111) and CHF patients' mutuality (indirect actor effect, B = 0.04; 95% CI, 0.010-0.103) mediated caregivers' family resilience and self-care contribution. Partner effect showed that caregivers' family resilience predicted CHF patients' self-care behaviour (direct partner effect, B = -0.334; 95% CI, -0.406 to -0.251). Chronic heart failure patients' family resilience had indirect effects on caregivers' contribution to self-care via patients' mutuality (indirect partner effect, B = 0.019; 95% CI, 0.001-0.066) and caregivers' mutuality (indirect partner effect, B = 0.025, 95% CI, 0.001-0.058). The results demonstrated a reciprocal influence on self-care between CHF patients and their caregivers. Family resilience within these dyads has impacted not only their own self-care but also those of their caregivers, with mutuality playing a mediating role. These results provided empirical support for improving the patients' self-care behaviour and caregivers' contribution at the dyadic level. Chinese Clinical Trial Registry: ChiCTR2200064561.