Heart failure (HF) contributes to poor physical and emotional health-related Quality of Life (HRQoL) and poor health outcomes. Coping strategies have been identified as essential in enhancing HRQoL. This 3-manuscript dissertation focuses on the stressor of heart failure (HF) associated severity and its relationship with coping and health-related quality of life (HRQoL). This dissertation is comprised of 3 manuscripts (a) a scoping review of literature on coping strategies and HRQoL; (b) a quantitative study of the associations between the stressor (HF severity), influencing factors (demographics [age, sex, education, and income] and HF duration), coping strategies (problem-focused, active emotion-focused, and avoidant emotion-focused), and physical and emotional HRQoL outcomes; and (c) a multiple mediation study that examines the mediating role of coping strategies between the stressor of HF severity and physical and emotional HRQoL.In chapter 2, a literature review was conducted following the Arksey and O’Malley template. This scoping review was guided by the TSCM. Eligibility criteria involved patients with HF, reported on coping strategies and HRQoL, and published in English. In chapters 3 and 4, a cross-sectional survey design was used. A convenience sample of individuals with HF were recruited online using Researchmatch.org. Using PROCESS macro for SPSS, a multiple mediation model was applied to evaluate if one or more coping strategy types served as a mediator between HF severity and emotional and/or physical HRQoL. In chapter 2, thirty-five studies were included (4 RCTs, 27 cross-sectional, and 4 qualitative/mixed methods). Active emotional coping (e.g., acceptance) and problem-focused (e.g., seeking social support) coping strategies were linked with better HRQoL, while avoidant emotional coping (e.g., denial) was linked to worse HRQoL. In the presence of the stressor of HF severity, key factors that influenced the types of coping strategy included sex, age, social support, income, education, spiritual beliefs, and illness duration. However, the evidence on the effectiveness of the type of coping on HRQoL remains inadequate due to the majority of studies being cross-sectional. The results of chapter 3 showed that 108 participants completed the study with an age range of 20-81 years (37.03±11.77 years). Most participants were male (57.4%, n=62) and self-identified as Black or African American (60.2%, n=65). The mediation analysis results showed that active emotion-focused coping mediated the relationship between all three NYHA classifications (II, III, and IV) and emotional, but not physical HRQoL. Finally, chapter 4 showed a statistically significant indirect effect on the emotional HRQoL through only active emotion-focused coping (X1=0.74 [95% CI: 0.01 to 1.97]; X2=0.73 [95% CI: 0.01 to 1.91]), which suggests that active emotion-focused coping served as a mediator between HF severity (all three NYHA classifications) and emotional HRQoL. This dissertation contributes to the science by recommending a consistent definition of the three types of coping and a better understanding of the influence of age, sex, education, income, and HF duration on coping strategies. This dissertation found that problem-focused and active emotion-focused coping were linked with improved physical and emotional HRQoL. Factors such as older age, male, and having a low level of education and lower level of income were showed as significantly associated with using more avoidant emotion-focused coping strategies, which can direct interventional work. Finally, this dissertation advances science by demonstrating that active emotion-focused coping serves as a mediator, playing an important role in mediating the effects between HF severity and emotional HRQoL. This will help initiating new intervention directions for nursing research, broadening the scope of education to enhance symptom management and QoL through nursing programs, and providing empirical evidence for clinicians to smoothly integrate into their practice. These contributions are expected to advance the field of HF science and care.
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