A Network Analysis of Health Literacy, Social Support, Spiritual Coping, Mutuality, and Self-Care in Patients with Chronic Heart Failure

<title>Abstract</title> <p>Background Self-care among patients with chronic heart failure (CHF) is shaped by interrelated psychosocial resources, including health literacy, social support, spiritual coping, and mutuality. However, how specific dimensions of these factors interact within a self-care-related system remains unclear. Methods This cross-sectional study included 280 patients with CHF. Self-care, heart failure-specific health literacy, social support, spiritual coping, and mutuality were assessed using validated questionnaires. A Gaussian graphical model with graphical least absolute shrinkage and selection operator regularization was estimated using scale dimensions and the mutuality total score as nodes, after adjustment for age, educational level, and duration of heart failure. Centrality, bridge strength, and node predictability were examined. Results The strongest edge in the network was identified between subjective support and objective support (weight = 0.46), followed by the edge between symptom perception and self-care maintenance (weight = 0.36). Communicative health literacy was the node with the highest strength centrality (1.57) and closeness centrality (1.56), followed by subjective support (strength = 1.18). Communicative health literacy (bridge strength = 0.75) and positive spiritual coping (bridge strength = 0.81) served as the bridge nodes connecting different communities in the network. Conclusions Communicative health literacy and subjective support were central factors in the self-care-related network, while positive spiritual coping and communicative health literacy linked different psychosocial communities. Nursing interventions that strengthen patient–provider communication, perceived social support, spiritual resources, and symptom monitoring may help support self-care in patients with CHF.</p>