Date of Award

Summer 2015

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Sebern, Margaret

Second Advisor

Topp, Robert

Third Advisor

Guttormson, Jill


Heart failure (HF) is a chronic condition affecting over 5 million Americans. Heart failure accounts for over 32 billion dollars in total cost each year, and is the most common cause of hospitalization for persons 65 years of age or older. Patients with HF experience poor self-care, are at risk for depressive symptoms, and have high rates of 30-day hospital readmissions. Social support influences depressive symptoms, self-care, and hospital readmissions. Shared care was used to operationalize social support. Shared care is a system of three relationship processes communication, decision making, and reciprocity, used to exchange social support. The purpose of this study was to determine if shared care moderated the relationship between depressive symptoms and self-care in community dwelling HF patients. A cross-sectional study was conducted with 89 patients receiving care from a HF clinic. The Stress-Buffering Model was used to guide the study. The Theory of Self-Care of Chronic Illness and the Processes of Self-Management were used to operationalize the definition of self-care and describe relationships between variables. Study variables of depressive symptoms, shared care, and HF self-care were assessed. Qualitative questions assessed subjective patient experiences related to study variables. Descriptive, correlation, and regression analysis were used to analyze quantitative data. Content analysis was used for qualitative data analysis. An association of shared care to depressive symptoms was supported by a significant inverse association between shared care communication and reciprocity and depressive symptoms. Partial correlation coefficients of shared care communication and reciprocity to depressive symptoms while controlling for HF severity were (rab.c = -.33) and (rab.c = -.20), respectively. Increased HF severity was associated with increased depressive symptoms. Older patients reported better self-care. The study supported prior research related to the role of social support in attenuating depressive symptoms, and the association between depressive symptoms and HF severity. Themes in qualitative data supported the difficulties patients experience and the importance of support from family caregivers. Patient’s perception of shared care with their caregiver is important to their psychological health. The development and testing of interventions to mobilize family caregiver support are essential for improving mental health in HF patients.