Self‐care perception and behaviour in patients with heart failure: A qualitative and quantitative study

Abstract

Background and objective Self-care strategies in heart failure (HF) are effective for disease management, yet adherence in many patients is inadequate. Reasons are presumably multifactorial but remain insufficiently investigated; thus, we aimed to analyse self-care adherence and associated factors in outpatients with HF. Methods and results To measure self-care levels and explore barriers and facilitators to self-care adherence in patients with HF, quantitative study using the European Self-Care Behaviour Scale (EHFScBS-9) (n = 80; NYHA II-III, mean age 72 ± 10 years, 58% male) and qualitative study using semi-structured interviews (n = 32; NYHA II-III, mean age 73 ± 11, 63% male) were conducted. We detected lowest adherence to regular exercise (39%) and contacts with healthcare provider in case of worsening symptoms (47%), whereas adherence was highest for regular medication taking (94%). Using the EHFScBS-9 standardized cut-off score ≤ 70, 51% of patients reported inadequate self-care. Binary logistic regression analysis showed significant influence of education (OR = 0.314, 95% CI: 0.103-0.959) and perceived control (OR = 1.236, 95% CI: 1.043-1.465) on self-care adequacy. According to the situation-specific theory of HF self-care, most commonly reported factors affecting the process of self-care were knowledge about HF self-care behaviours (84%), experience with healthcare professionals (84%), beliefs about their expertise (69%) and habits related to medication taking (72%). Among values, working responsibilities (53%) and maintenance of traditions (31%) appeared as the most prevalent socially based values affecting motivation for selfcare. Situational characteristics related to the person (self-confidence, 53%; adaptive coping strategies, 88%), problem (burdensome breathing difficulties, 56%; co-morbidities, 81%) and environment (practical support from family/caregivers, 59%; financial difficulties, 50%) were also commonly reported. Conclusions Various factors, including health-related beliefs, habits and socially based values, need to be taken into account when planning self-care interventions in patients with HF. A patient tailored approach should be based on adequate patient evaluation, taking into consideration the particular personal and social context.

Life Events and Adaptive Coping Approaches to Self-Management From the Perspectives of Hospitalized Cardiovascular Patients: A Qualitative Study

“…Social expectations regard working as role responsibility within socialization, while body conditions have prevented better working activities due to time of shifts, working places, and work intensity. In line with the findings in a mixed-methods study ( 31 ), patients with heart failure continued to work due to socially based values until they were highly symptomatic.…”

“…According to Whitehead et al, surveillance and support from families could create a context of self-management and promote adherence to daily self-care ( 44 ). Conversely, some participants would not like to be accompanied by others only if when they perceived they were in an extremely severe body condition, for some were reluctant to seek help and some were reluctant to become a burden ( 31 ).…”

Self-care Behaviors among Sudanese Patients with Heart Failure: A Cross-sectional Assessment

“…But generally, our findings are consistent with other reports that showed the adherence to monitoring body weight was poor, while adherence to prescribed medications was good in the majority of them [12,13]. Furthermore, binary logistic regression analysis indicated that gender, marital status, educational level, and comorbidity weren't significantly associated with adherence to self-care recommendations this was contrary to the study conducted in HF Slovenian patients [21].…”

The Situation-Specific Theory of Heart Failure Self-care

“…Conversely, unfavorable attitudes about specific behaviors (eg, diet, exercise, medication) as difficult, not beneficial, or harmful may serve as barriers to effective self-care. 77 To date, researchers exploring attitudes about HF self-care have used mostly qualitative methods to describe how attitudes influence self-care, 77 including adherence to diet, 78 medication, 50 , 79 and treatment-seeking delays for symptom management. 50 , 74 , 80 Results confirm that HF self-care is more likely when attitudes are favorable.…”