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cognition, family, mixed methods, naturalistic decission making, sleep



  1. Riegel, Barbara
  2. Vaughan Dickson, Victoria
  3. Goldberg, Lee R.
  4. Deatrick, Janet A.


Background: Self-care is vital for successful heart failure (HF) management. Mastering self-care is challenging; few patients develop sufficient expertise to avoid repeated hospitalization.


Objective: To describe and understand how expertise in HF self-care develops.


Methods: Extreme case sampling was used to identify 29 chronic HF patients predominately poor or particularly good in self-care. Using a mixed-methods (qualitative and quantitative) design, participants were interviewed about HF self-care, surveyed to measure factors anticipated to influence self-care, and tested for cognitive functioning. Audiotaped interviews were analyzed using content analysis. Qualitative and quantitative data were combined to produce a multidimensional typology of patients poor, good, or expert in HF self-care.


Results: Only 10.3% of the sample was expert in HF self-care. Patients poor in HF self-care had worse cognition, more sleepiness, higher depression, and poorer family functioning. The primary factors distinguishing those good versus expert in self-care were sleepiness and family engagement. Experts had less daytime sleepiness and more support from engaged loved ones who fostered self-care skill development.


Conclusion: Engaged supporters can help persons with chronic HF to overcome seemingly insurmountable barriers to self-care. Research is needed to understand the effects of excessive daytime sleepiness on HF self-care.