. 2011 Mar 31;4:39–51. doi: 10.2147/JMDH.S8174

Table 1.

Selected studies reporting on characteristics that influence self-management in HF patients

Reference	Study design	Results	Comments
Artinian³⁹	Descriptive correlation study to examine relationship between select characteristics (personal/environmental factors) and self-management behaviors in convenience sample of 110 HF patients.	No significant relationship between select characteristics and the specific HF measure (SCHFI). Trends observed: older age more adherent with taking medications, keeping appointments, and getting flu shot. Younger patients less likely to discuss worsening symptoms. When living alone, less likely to seek help when short of breath or contact physician when symptomatic, and more likely to report being physically active. Low income patients living alone: more likely to eat canned and packaged foods. If perceived poor health, more apt to rest, limit activities, ask for help, and contact their doctor regarding symptoms. Three of top 5 most frequently performed HF behaviors related to taking prescribed medications; 5 least frequently performed behaviors concerned with symptom management/monitoring.	CDSM in HF is varied set of behaviors influenced by diverse factors. Understanding influential effects of characteristic performance of HF behaviors is first step to tailoring interventions to patients’ situation.
Cameron¹⁹	Descriptive correlation study to test conceptual model of determinants of HF self-management; convenience sample of 50 consecutive patients hospitalized with HF in Australia from June to December 2005.	Four variables contributed significantly to variance in HF self-management (self-reported behaviors): 1) gender, 2) moderate to severe comorbidity, 3) depressions, and 4) self-care confidence. Results of study illustrate characteristics associated with low levels of HF self-management in an Australian population.	Further research to investigate the interplay between nonmodifiable characteristics and the application of CDSM selectively directed to those in greatest need of improvement in self-management.
Chriss³⁷	Non-experimental, correlational, test–retest study (baseline and 3 months) from a sample of 66 chronic HF patients; replicating a model using 7 variables: social support, symptom severity, comorbidity, education, age, gender, and income; in this analysis, the last variable income was not included due to problems with missing data.	Significant predictors of self-management were higher age and male gender. Elderly men and those with fewer comorbid illnesses were most successful with HF self-management.	Extra instructional support/follow-up for elderly female patients with HF and those with several comorbid conditions needed. Further research needed to identify why predictors of HF self-management change over time.
Moser³³	Descriptive study to examine multiple risk factors for rehospitalization in recently discharged HF patients; convenience sample of 202 participants in RCT of a home-based HF disease management intervention. Data reported were collected at baseline prior to interventions.	Results: 70% NYHA III/IV; 80% >1 comorbidity, 48% >2; large percentage (88% NYHA III and 52% NYHA IV) lived alone; high level anxiety (50%) and depression (69%); substantially impaired HRQoL and symptom burden; poor (<31%) symptom recognition, poor adherence with recommended self-management strategies (14% got weights – 9% monitored symptoms for worsening HF). Of the entire sample, 23% had all of the following risk factors: NYHA III/IV lived alone, 1 comorbidity, and depression/anxiety.	HF patients may be deemed medically stable for hospital discharge but exhibit psychosocial and behavioral risk factors that make them vulnerable for rehospitalization. Need to develop strategy to assess risk factors and provide early care to HF patients after discharge to improve chronic care and CDSM support.
Richardson⁴³	Review of psychological variables (depression, social support, and adherence) in patients with HF.	Summarizes issues that surround depression and social support in HF patients: many reported cases but many not optimally treated; potential for higher rates of readmission in HF patients with depression or lack of social support; NP in optimal position to evaluate psychosocial and adherence issues in HF patients; need for additional studies to assess.	Conclusion that negative effects of depression and lack of support on clinical outcomes in HF patients can be noteworthy and need further research.
Riegel⁴⁰	Qualitative study using a convenience sample of 26 patients with chronic HF; structured interviews to examine how HF influences daily life; assess how patients perform self-care; and determined how patients’ life situations facilitate or impede HF self-care.	Physical limitations, debilitating symptoms, difficulties coping with treatment, lack of knowledge, distressed emotions, multiple comorbidities and personal struggles were common findings.	Assess motivation, acknowledge success, and apply a stepped approach to CDSM. Helping patients identify barriers may facilitate self-management.
Riegel⁴¹	Extreme case sampling using mixed-methods design in 29 chronic HF patients; to describe and understand how expertise in HF self-care develops.	Ten percent of sample were expert in HF self-care. Poor HF self-care associated with worse cognition, more sleepiness, depression, and worse family functioning. Factors distinguishing good vs expert self-care were sleepiness and family engagement.	Engaged supporters can foster self-care skill development in patients with HF. More research needed to understand effects of daytime sleepiness on HF self-care.
Rockwell³⁸	Descriptive correlation study, replicating model of 7 variables derived from MSCCI³⁶ as predictors of HF self-care in convenience sample of 209 adults (≥18) participating in community CDSM program.	Typical participant: age 73; Class III NYHA; married; grade-school education; earning income <$20,000 per year; equal gender. Educational level and symptom severity were identified as predictors of self-management, explaining 10.3% of the variance.	Better educated persons may be more likely to engage in self-management than those who are poorly educated. Patients with more severe symptoms are more likely to be knowledgeable about importance of HF symptoms.
Sayers⁴⁴	Descriptive study to examine the effects of social support in a convenience sample of 74 participants with HF.	Self-management was poor as measured across several self-care domains. Age associated with increased levels of perceived social support, suggesting that those involved with aging HF patients respond to their need for greater support. Perceived support moderately associated with better self-reported medication and dietary adherence and other aspects of self-management (ie, daily weighing).	Higher levels of self-management are important correlates of social support and may explain how social support influences HF outcomes. Support can influence clinical care for HF patients focusing on improving self-management.
Zambroski³¹	Descriptive, cross-sectional study in convenience sample of 53 patients (>40) with mild NYHA II–IV HF.	HF patients experience a mean of 15.1 ± 8.0 symptoms. Shortness of breath and lack of energy were most prevalent; difficulty sleeping most burdensome symptom; lower age, worse functional status, total symptom prevalence, and total symptom burden predicted 67% of variance in HRQoL.	Patients with HF experience a high level of symptom burden.

Abbreviations: HF, heart failure; CDSM, chronic disease self-management; NYHA, New York Heart Association; HRQoL, health related quality of life.