Caregiver Self-Efficacy as a Mediator of Caregiver Contribution to Self-Care in Coronary Heart Disease: A Cross-Sectional Structural Equation Modeling Study

Background: Self-care is a determinant of long-term outcomes in coronary heart disease, yet it remains suboptimal in many patients. Informal caregivers support patient self-care, but the mechanisms underlying variability in caregiver contribution (CC) are not fully understood. This study examined whether caregiver self-efficacy mediates the association between caregiver characteristics and CC to self-care across the domains of self-care maintenance, self-care monitoring, and self-care management. Methods: This cross-sectional study analyzed baseline data from 155 informal caregivers enrolled in the Italian HEARTS-IN-DYADS study. Caregiver contribution to self-care was measured using the CC to Self-Care of Coronary Heart Disease Inventory, and self-efficacy using the Caregiver Self-Efficacy in Contributing to Self-Care scale. Structural equation models were estimated separately for each CC to self-care domain, with self-efficacy specified as a mediator. Results: The CC scores were below the adequacy threshold across all domains, whereas self-efficacy scores were adequate. All models demonstrated excellent fit. Caregiver self-efficacy was a consistent predictor of CC across all domains (β = 0.34-0.51, P < .001). Indirect effects via self-efficacy were observed for occupation, education, and caregiving hours. Direct effects emerged primarily in the monitoring domain, where age, education, financial adequacy, and caregiving hours were associated with CC. The models explained 17%-33% of the variance in CC and 10% in self-efficacy. Conclusions: Caregiver self-efficacy is a key factor associated with CC to self-care in coronary heart disease and may represent a potential target for interventions aimed at improving caregiver involvement in patient self-care.