Factors influencing self-care among older patients with heart failure and spouses in China: a mixed methods study

Abstract

Objective This study aimed to investigate the factors influencing self-care among older patients with heart failure (HF) and their spouses from a dyadic perspective. Methods An explanatory sequential mixed-methods design was employed. In the quantitative phase, 145 dyads of older HF patients and their spouses were recruited from a tertiary hospital in Zhejiang, China. Validated instruments were used to measure patient self-care, spouse contribution to self-care, disease-specific health literacy, mutuality, and social support. Multiple linear regression and the Actor-Partner Interdependence Model (APIM) were conducted separately for three self-care subscales (maintenance, management, confidence). In the qualitative phase, 10 dyads were purposively sampled for one-to-one semi-structured interviews, and data were analyzed via Colaizzi’s phenomenological method. Quantitative and qualitative findings were integrated adhering to the Theory of Dyadic Illness Management (TDIM). Results Both patients and spouses scored below the 70-point adequacy threshold across all three self-care subscales. APIM revealed significant actor effects of health literacy and mutuality on self-care for both dyad members. Significant partner effects were observed in two dimensions: spouse mutuality was positively associated with patient self-care maintenance (B = 5.352, 95% CI: 0.631–9.828, p = 0.027), and spouse health literacy was positively associated with patient self-care confidence (B = 0.364, 95% CI: 0.193–0.533, p < 0.001). No significant partner effect was detected in the self-care management dimension, which showed suboptimal model fit and was thus interpreted as exploratory. No significant paths of traditional social support were retained in final models. Qualitative findings identified four thematic levels (individual, dyadic, family/social, cultural), supplementing contextual factors such as economic burden, reliance on digital healthcare services, and neglect of spousal caregivers. The integration provided a plausible contextual hypothesis for the null quantitative association between traditional social support and self-care. Conclusion Health literacy and mutuality are core correlates of self-care among older Chinese HF patient-spouse dyads, with dimension-specific dyadic interaction patterns. Clinical interventions should develop tailored dyadic support strategies for distinct self-care dimensions, and pay attention to optimizing age-friendly digital healthcare services and improving caregiving culture. This study provides exploratory evidence for context-specific extension of the TDIM framework.