congestive heart failure, medical adherence, self-care determinants, self-care predictors, self-management



  1. Siabani, Soraya MD, PhD(c)
  2. Driscoll, Tim BSc (Med), MB, BS, MOHS, PhD
  3. Davidson, Patricia M. PhD, RN, FAAN
  4. Najafi, Farid MD, PhD
  5. Jenkins, Marisa C. RN, BHSc(Nsg), MNsg(Manag), MScMed (ClinEpi)
  6. Leeder, Stephen R. MD, PhD, FRACP


Background: Chronic heart failure (CHF) is an increasing and costly health problem worldwide. Effective self-care behaviors reduce the cost and improve CHF outcomes. Interventions targeting improvement of self-care need to identify the baseline status of patients and factors associated with self-care to tailor the programs to patients' needs.


Aim: The aim of this study was to describe self-care and its predictors in patients with CHF in western Iran.


Methods: In a cross-sectional study, 255 patients with CHF in Kermanshah were recruited and 231 (mean [SD] age, 66 [13] years; 51.5% women) completed the interviews. Self-care maintenance, self-care management, and self-care confidence were evaluated using a Persian heart failure self-care index. Each of these 3 measures had a total possible score of 100, with 22 indicators.


Results: The mean (SD) self-care scores were low: maintenance, 33.8 (10.7); management, 32.2 (12.0); and confidence, 43.6 (15.6). Self-care maintenance was significantly and positively associated with education, disease duration, and living conditions. Self-care management was significantly and positively associated with education and number of hospital admissions. However, the parameter estimates in all those relationships were small.


Conclusion: Self-care in patients with CHF in Iran needs major improvement, and many determinants of self-care identified by other studies were not consistently associated with poor self-care scores in Iran. Further research considering a wide range of factors associated with self-care (eg, socioeconomic and health system-related factors) and application of culturally relevant interventional strategies is recommended.