EXPLORING PERSONAL GROWTH IN COMMUNITY-RESIDING ADULTS WITH HEART FAILURE
Background: HF is a chronic, progressive disease affecting over five million Americans and is associated with significant mortality, symptom burden, and uncertainty due to an unpredictable disease trajectory. Personal growth defined as the ability to perceive positive psychosocial change as a result of significant adversity has been associated with beneficial clinical and patient-centered outcomes in other illnesses, but has been little studied in HF. This research was guided by Tedeschi and Calhoun’s post-traumatic growth model and Mishel’s reconceptualized uncertainty in illness theory.
Methods: A convenience sample of 103 adults with New York Heart Association (NYHA) class II-IV HF participated in this descriptive, exploratory study. All participants were recruited from an outpatient cardiology clinic. Participants completed a demographic and clinical survey, the Posttraumatic Growth Inventory (PTGI), the Mishel Uncertainty in Illness Scale-Community Version (MUIS-C), and the Memorial Symptom Assessment Scale-Heart Failure (MSAS-HF). Descriptive statistics depicted demographic and clinical characteristics. Bivariate correlations among age, time since diagnosis, and PTGI, MUIS-C, and MSAS-HF scores were examined using Pearson product-moment correlation coefficients. Independent t-tests were used to assess differences in PTGI scores by sex, ethnicity, and disease severity. Multiple regression was used to assess the extent to which these variables made independent contributions to predicting PTGI scores. The sample size was sufficient to achieve 80% power to detect a medium effect size (f2 = .15 ≈ R2 = .13) for a regression model with up to 7 predictors at an alpha level of .05.
Results: Participants reported moderate levels of personal growth (M = 48.6, SD = 28.6). There were no significant differences in personal growth by sex, ethnicity, or disease severity. Personal growth had a weak, negative correlation with age (r = –.20, p < .05) and a weak, positive correlation with symptom burden (r = .20, p < .05). Uncertainty was positively correlated with symptom burden (r = .49, p <.01) and disease severity (r = .28, p < .01), but was not significantly correlated with PTGI scores. A hierarchical regression model that included age, sex, ethnicity, NYHA classification, years since diagnosis, uncertainty, and symptom burden did not account for significant variance in PTGI scores.
Implications: Community-residing adults with stable HF report personal growth that is not explained by demographics, time since diagnosis, disease stage, uncertainty, or symptom burden. Assessment in more diverse samples and clinical settings is needed to understand the factors that contribute to personal growth in HF, and longitudinal assessment would be needed to understand the trajectory of personal growth over time. Enhanced understanding of personal growth would be useful for informing supportive care models and to clarify how nurses and other health care providers facilitate or hinder personal growth for patients with HF.