Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Susan Frazier


The purpose of this dissertation was to evaluate outcomes associated with social support in patients with heart failure and their caregivers. Specific aims were to: 1) examine the association of depressive symptoms with self-care in patients with HF; 2) evaluate the psychometrics properties of the Multidimensional Scale of Perceived Social Support (MSPSS) instrument as a measure of perceived social support in patients with heart failure; and 3) determine whether patient and caregiver perception of relationship quality measured at baseline upon enrollment predicted quality of life at baseline in both patient and caregiver using a multilevel dyadic analysis in patient and caregiver.

Specific aim one was addressed by secondary analysis data from patients with heart failure enrolled in the Rural Education to Improve Outcomes in Heart Failure (REMOTE-HF) clinical trial. Multiple linear regression was used to determine whether depressive symptoms were associated with self-care, while controlling for age, sex, ethnicity, education level, and New York Heart Association functional class. The presence of depressive symptoms predicted worse self-care in patients with heart failure. For the second specific aim, the psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) and its subscales were investigated. The MSPSS reliability and validity were supported by measures of internal consistency reliability, factor analysis, and hypothesis testing. The third specific aim was met with an investigation of the patient and caregiver to examine whether relationship quality measured at baseline influenced quality of life measured at baseline in patient-caregiver heart failure dyads. The Actor Partner Interdependence Model (APIM) demonstrated both actor and partner effects for the patient and caregiver. Relationship quality was associated with quality of life in patient-caregiver dyads.

Digital Object Identifier (DOI)