# The association between social capital and self-care behaviors in patients with heart failure: A cross-sectional study

## TL;DR

This study explores how social capital influences self-care behaviors in heart failure patients, suggesting that community participation and social engagement could improve patient outcomes.

## Contribution

The study introduces social capital as a novel factor influencing heart failure self-care, highlighting modifiable aspects like community participation.

## Key findings

- Higher social capital was positively correlated with better self-care maintenance, symptom perception, and symptom management.
- Community participation and proactive social engagement were independently associated with improved self-care behaviors.
- Most patients exhibited inadequate self-care, indicating a need for integrating social capital assessments into heart failure care.

## Abstract

Alongside pharmacological management, self-care is crucial for reducing morbidity and rehospitalization in heart failure patients. Previous studies have identified various medical, individual, and system barriers, particularly low social support. While social support focuses on the immediate patient environment (microsystem), social capital includes broader factors (exosystem, macrosystem), which remain unexplored in heart failure self-care.

A multicenter cross-sectional study involving 157 heart failure patients (left ventricular ejection fraction≤50 or diastolic dysfunction) was conducted using stratified multistage sampling from hospitals and clinics affiliated with Shiraz University of Medical Sciences. Heart failure self-care was assessed using the Self-Care of Heart Failure Index (version 7.2), and social capital was measured via the 36-item Onyx and Bullen scale. Generalized linear models with leave-one-out cross-validation identified independent predictors of adequate self-care (score≥70), adjusting for demographic, clinical, and behavioral covariates, including self-care confidence.

Social capital scored relatively low to moderate (standardized median: 47.222, 95% confidence interval [95%CI]: 35.484–58.065). Higher social capital was positively correlated with self-care maintenance (p = 0.003), symptom perception (p = 0.019), and symptom management (p = 0.035). In multivariate models, community participation was associated with self-care maintenance (odds ratio [OR]: 1.026, 95%CI: 1.008–1.045, p = 0.004), symptom perception (OR: 1.025, 95%CI: 1.003–1.048, p = 0.028), and symptom management (OR: 1.025, 95%CI: 1.003–1.048, p = 0.024), all independent of confidence. Proactive engagement in social activities, also independent of confidence, was associated with symptom perception (OR: 1.031, 95%CI: 1.005–1.058, p = 0.021) and symptom management (OR: 1.038, 95%CI: 1.009–1.067, p = 0.009). This domain was associated with maintenance in models without confidence (OR: 1.027, 95%CI: 1.008–1.046, p = 0.005), but attenuated after adjustment for confidence, indicating the association was not independent of confidence. The significant association of community trust and safety with better maintenance and symptom perception also attenuated after accounting for confidence. Stronger work connections were also linked to these two domains, independent of confidence.

Notably, most patients with heart failure exhibited inadequate self-care across all domains. Social proactivity and community participation, scarcely studied yet potentially modifiable aspects of social capital, were positively associated with self-care behaviors. From these findings, we suggest that integrating social capital assessments into multidisciplinary heart failure care can help nurses tailor behavioral interventions and strengthen community-based support strategies. Future interventional trials should evaluate targeted social-capital interventions as a novel adjunct to nursing-led self-care support in heart-failure patients.

IR.SUMS.MED.REC.1404.205.