Resilience in Informal Caregivers of Patients with Heart Failure in China: Exploring Influencing Factors and Identifying the Paths

Background: In the fight against heart failure (HF), informal caregivers are an indispensable part of the team. As a protective factor against stress, resilience can help to enhance caregivers' psychological adaptation and ultimately increase the quality of care during the HF caregiving period. Recognizing its predictors and exploring how these variables interact could promote tailored strategies to enhancing caregivers' resilience of HF patients. Thus, this study aimed to identify promoting and risk factors of resilience in informal caregivers of HF patients from the Chinese context and to understand the interactions between these factors and resilience.Methods: This cross-sectional study was conducted from December, 2020 to March, 2022 among 210 caregivers in Nanjing, China. The General Information Questionnaire, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Perceived Social Support Scale, the Positive and Negative Affect Scale, the Simplified Coping Style Questionnaire and the Family Hardiness Index were used in this survey. Data were analysed with Pearson's correlation analysis, the multiple linear regression model and the structural equation modeling (SEM).Results: The resilience of 210 Chinese HF caregivers was at the moderate and higher level (66.40 +/- 15.08). The SEM had a good fit (root mean square error of approximation=0.047, comparative fit index=0.994, Tucker-Lewis index=0.987). Perceived social support (beta=0.390, P<0.001), positive coping style (beta=0.159, P=0.019) and self-efficacy (beta=0.332, P<0.001) had positive direct effects on resilience among HF caregivers, separately. Both perceived social support (beta=0.04, P<0.001) and self-efficacy (beta=0.07, P<0.001) indirectly influenced resilience through positive coping style. Conclusion: We recommended that multi-dimensional and greater social support, higher self-efficacy and especially, positive coping strategies should be offered or encouraged during the caregiving period, which may contribute to enhancing HF caregivers' resilience.