Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured

Abstract

Background: Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief coping orientation to problems experienced (COPE), a self-reporting questionnaire, has been previ-ously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for group-ing the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associa-tions between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF. Method: One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strate-gies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regres-sion analyses explored associations of aggregated coping strategies with HRQoL. Results: A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused cop-ing, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF. Conclusions: This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assess-ment of coping both in clinical and research settings.