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self-care, heart failure, confidence, activity status



  1. Riegel, Barbara
  2. Lee, Christopher S.
  3. Albert, Nancy
  4. Lennie, Terry
  5. Chung, Misook
  6. Song, Eun Kyeung
  7. Bentley, Brooke
  8. Heo, Seongkum
  9. Worrall-Carter, Linda
  10. Moser, Debra K.


Background: In a previous, small, mixed-methods study, heart failure patients were described as novice, expert, or inconsistent in self-care. In that study, self-care types differed in experience, confidence, attitudes, and skill.


Objectives: The aims of this study were to validate the novice-to-expert self-care typology and to identify determinants of the heart failure self-care types.


Methods: A cross-sectional descriptive study was performed using data from 689 adults with heart failure (61 +/- 2.5 years; 36% female, 50% New York Heart Association class III). Two-step likelihood cluster analysis was used to classify patients into groups using all items in the maintenance and management scales of the Self-care of Heart Failure Index. Multinomial regression was used to identify the determinants of each self-care cluster, testing the influence of age, gender, left ventricular ejection fraction, body mass index, depression, anxiety, hostility, perceived control, social support, activity status (Duke Activity Status Index), and self-care confidence.


Results: Self-care behaviors clustered best into three types: novice (n = 185, 26.9%), expert (n = 229, 33.2%), and inconsistent (n = 275, 39.9%). The model predicting self-care cluster membership was significant ([chi]2 = 88.67, p < .001); Duke Activity Status Index score and Self-care of Heart Failure Index confidence score were the only significant individual factors. Higher activity status increased the odds that patients would be inconsistent (odds ratio [OR] = 1.02-1.09) or novice (OR = 1.02-1.10) in self-care. Higher self-care confidence increased the odds of being an expert (OR = 1.05-1.09) or inconsistent (OR = 1.01-1.05) in self-care.


Discussion: The three-level typology of heart failure self-care was confirmed. Patients who have fewer limitations to daily activities may not be driven adequately to engage in heart failure self-care and may need extra assistance in developing expertise.