Abstract
Background: Heart failure (HF) is a prevalent, progressive, and costly chronic condition.1 Unfortunately, persons of color (POC) and individuals who are socioeconomically disadvantaged have higher rates of HF and experience worse outcomes.2 Reducing HF hospitalizations and improved outcomes are possible if individuals consistently perform HF self-care practices such as medication adherence; monitoring salt and fluid intake; tracking weight changes; and responding to symptoms of worsening HF.3 However, approximately 50% of people with HF do not adhere to these practices.4 Researchers have identified that social determinants of health such as living conditions adversely affect HF outcomes,5–7 yet it is unclear the impact that residing in a disadvantaged neighborhood can have on HF self-care adherence.
Purpose: The study aim was to examine whether living in a socioeconomically disadvantaged neighborhood was predictive of HF self-care adherence among people with a 90-day HF readmission. The influence of race, annual household income, and level of education on HF self-care adherence was also examined.
Methods: This cross-sectional, correlational study was a secondary analysis of baseline data collected for a mixed-method investigation of medication adherence among people with a 90-day HF hospital readmission. Zip codes and the Area Deprivation Index (ADI)8 were used to determine the level of socioeconomic disadvantage within participant’s neighborhood. A zip code with an ADI of >8 was considered a disadvantaged neighborhood.9 The Self-Care Maintenance and Self-Care Management subscales of the Self-Care of Heart Failure Index10 were used to measure HF self-care adherence. Multiple regression was used to test if ADI, race, annual household income, and level of education significantly predicted HF self-care adherence. A diverse sample was recruited for this study.
Results: Of the 82 study participants, 58.5% were male, 58.5% were POC, and the mean age was 65 years. A high degree of socioeconomic disadvantage (ADI >8) within a participant’s neighborhood was the only predictor of HF self-care nonadherence (Self-Care Maintenance R2= .16, F(4, 73)= 3.65, p= .01; Self-Care Management R2= .14, F(4, 73)= 3.19, p= .02). Although race, annual household income, and level of education were not selected for the final regression model, POC were more likely than Whites to reside in socioeconomically disadvantaged neighborhoods (t(80)= -1.88, p= < .01) and POC (t(80)= 1.48, p= < .01) and those with lower education (t(80)= -1.98, p= < .01) were more likely to have inadequate HF self-care.
Conclusion: Findings suggest that residing in a socioeconomically disadvantaged neighborhood predicts HF self-care nonadherence. Individual-level social determinants of health such as race, income, and education did not explain HF self-care adherence. These findings highlight that people in socioeconomically disadvantaged neighborhoods may face unique challenges that negatively affect HF self-care adherence. Nurses must be proactive in advocating for policies and initiatives that address the root causes of health disparities and work to reduce barriers to HF self-care adherence for patients living in socioeconomically disadvantaged neighborhoods. Future research should seek to understand the factors within socioeconomically disadvantaged neighborhoods that influence HF self-care adherence.
Notes
References:
Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation. 2022;145(8):e153-e639. doi:10.1161/CIR.0000000000001052
Glynn P, Lloyd-Jones DM, Feinstein MJ, Carnethon M, Khan SS. Disparities in cardiovascular mortality related to heart failure in the United States. J Am Coll Cardiol. 2019;73(18):2354-2355. doi:10.1016/j.jacc.2019.02.042
Pobrotyn P, Mazur G, Kałużna-Oleksy M, Uchmanowicz B, Lomper K. The level of self-care among patients with chronic heart failure. Healthcare. 2021;9(9):1179. doi:10.3390/healthcare9091179
Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Consumers and Communication Group, ed. Cochrane Database Syst Rev. 2020;2020(5). doi:10.1002/14651858.CD012419.pub2
Enard KR, Coleman AM, Yakubu RA, Butcher BC, Tao D, Hauptman PJ. Influence of social determinants of health on heart failure outcomes: A systematic review. J Am Heart Assoc. 2023;12(3):e026590. doi:10.1161/JAHA.122.026590
White-Williams C, Rossi LP, Bittner VA, et al. Addressing social determinants of health in the care of patients with heart failure: A scientific statement from the American Heart Association. Circulation. 2020;141(22). doi:10.1161/CIR.0000000000000767
Bevan GH, Josephson R, Al-Kindi SG. Socioeconomic deprivation and heart failure mortality in the United States. J Card Fail. 2020;26(12):1106-1107. doi:10.1016/j.cardfail.2020.07.014
Kind A. Neighborhood Atlas- home. Wisc.edu. Accessed September 25, 2023. https://www.neighborhoodatlas.medicine.wisc.edu/
Johnson AE, Zhu J, Garrard W, et al. Area deprivation index and cardiac readmissions: evaluating risk prediction in an electronic health record. J Am Heart Assoc. 2021;10(13):e020466. doi:10.1161/JAHA.120.020466
Riegel B, Barbaranelli C, Carlson B, et al. Psychometric testing of the revised self-care of heart failure index. J Cardiovasc Nurs. 2019;34(2):183-192. doi:10.1097/JCN.0000000000000543
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Mixed/Multi Method Research
Keywords:
Socioeconomic Disparities in Health, Poor Communities, Heart Failure, Health Self-Care, Patient Compliance
Recommended Citation
Meraz, Rebecca; Osteen, Kathryn A.; Noblitt, Paul; Viejo, Henry; Angosta, Alona; and McGee, Jocelyn S., "Impact of Social Determinants of Health and Neighborhood Socioeconomic Disadvantage on Heart Failure Self-Care Adherence" (2026). International Nursing Research Congress (INRC). 3.
https://www.sigmarepository.org/inrc/2024/presentations_2024/3
Conference Name
35th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Singapore
Conference Year
2024
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-11-03
Impact of Social Determinants of Health and Neighborhood Socioeconomic Disadvantage on Heart Failure Self-Care Adherence
Singapore
Background: Heart failure (HF) is a prevalent, progressive, and costly chronic condition.1 Unfortunately, persons of color (POC) and individuals who are socioeconomically disadvantaged have higher rates of HF and experience worse outcomes.2 Reducing HF hospitalizations and improved outcomes are possible if individuals consistently perform HF self-care practices such as medication adherence; monitoring salt and fluid intake; tracking weight changes; and responding to symptoms of worsening HF.3 However, approximately 50% of people with HF do not adhere to these practices.4 Researchers have identified that social determinants of health such as living conditions adversely affect HF outcomes,5–7 yet it is unclear the impact that residing in a disadvantaged neighborhood can have on HF self-care adherence.
Purpose: The study aim was to examine whether living in a socioeconomically disadvantaged neighborhood was predictive of HF self-care adherence among people with a 90-day HF readmission. The influence of race, annual household income, and level of education on HF self-care adherence was also examined.
Methods: This cross-sectional, correlational study was a secondary analysis of baseline data collected for a mixed-method investigation of medication adherence among people with a 90-day HF hospital readmission. Zip codes and the Area Deprivation Index (ADI)8 were used to determine the level of socioeconomic disadvantage within participant’s neighborhood. A zip code with an ADI of >8 was considered a disadvantaged neighborhood.9 The Self-Care Maintenance and Self-Care Management subscales of the Self-Care of Heart Failure Index10 were used to measure HF self-care adherence. Multiple regression was used to test if ADI, race, annual household income, and level of education significantly predicted HF self-care adherence. A diverse sample was recruited for this study.
Results: Of the 82 study participants, 58.5% were male, 58.5% were POC, and the mean age was 65 years. A high degree of socioeconomic disadvantage (ADI >8) within a participant’s neighborhood was the only predictor of HF self-care nonadherence (Self-Care Maintenance R2= .16, F(4, 73)= 3.65, p= .01; Self-Care Management R2= .14, F(4, 73)= 3.19, p= .02). Although race, annual household income, and level of education were not selected for the final regression model, POC were more likely than Whites to reside in socioeconomically disadvantaged neighborhoods (t(80)= -1.88, p= < .01) and POC (t(80)= 1.48, p= < .01) and those with lower education (t(80)= -1.98, p= < .01) were more likely to have inadequate HF self-care.
Conclusion: Findings suggest that residing in a socioeconomically disadvantaged neighborhood predicts HF self-care nonadherence. Individual-level social determinants of health such as race, income, and education did not explain HF self-care adherence. These findings highlight that people in socioeconomically disadvantaged neighborhoods may face unique challenges that negatively affect HF self-care adherence. Nurses must be proactive in advocating for policies and initiatives that address the root causes of health disparities and work to reduce barriers to HF self-care adherence for patients living in socioeconomically disadvantaged neighborhoods. Future research should seek to understand the factors within socioeconomically disadvantaged neighborhoods that influence HF self-care adherence.
Description
It is unclear whether living in a socioeconomically disadvantaged neighborhood and individual-level social determinants of health impact heart failure self-care adherence. Findings suggest that residing in a socioeconomically disadvantaged neighborhood predicts self-care nonadherence. Race, annual household income, and level of education did not explain self-care adherence.