Authors:

H S J Chew¹ , K L D Sim² , X Cao¹ , S Y Chair¹ , ¹The Chinese University of Hong Kong, Nursing - Hong Kong - Hong Kong , ²National University Heart Centre, Cardiology - Singapore - Singapore ,

Citation:

Background

Though self-care improves patient outcomes and quality of life, it remains suboptimal in majority of heart failure. Interventions such as education programs have been shown to improve self-care but insufficiently due to patients’ low motivation to change lifestyle habits. Better understanding of how behaviour change materialise in this population is needed.

Purpose

To understand the mechanism by which self-care is motivated and improved in patients with heart failure.

Method

Explanatory sequential mixed-method. Suitable heart failure patients were purposively sampled from a quantitative study conducted at one tertiary hospital. Thematic analysis with constant comparison was employed. Qualitative and quantitative data were integrated using the Temporal Self-regulation Theory used to guide the study.

Results

Seventeen participants were interviewed. Mean age was 56, mostly male (76.5%), Chinese ethnicity (82.4%), married (82.4%), earning less than $3 000(70.6%), secondary school educated (47.1%), working full-time (41.2%), Buddhist (35.3%), New York Heart Association functional (NYHA) class II (70.6%) and staying with their family (100%). Mean self-care maintenance score was suboptimal (44.5; cut-off score ³70). Two motivators associated with emotional attachment were identified: to bargain for more time to (1) love family - by preventing worry and grief and providing support and (2) love self - by righting the wrongs an regain feeling of normalcy. Three barriers were identified: (1) difficulty adopting physical activity due to – time constraint and fear of overexertion; (2) difficulty deviating from sociocultural dietary norms and habits due to – convenience of eating out, difficulty making dietary requests, respecting cooks other diners and unhealthy food habits and (3) difficulty controlling the future due to – perceived short residual lifespan and perceived futility. Personalised strategies to overcome each barrier includes: integrating physical exercise into daily living and enjoyable activities, self-monitoring, making food adaptations, meal preparations, damage control, self-regulation (i.e. ignoring, distracting, substituting and cognitive reframing) and positive thinking.

Conclusion

Clinicians and case managers could motivate and empower self-care by eliciting each patients’ motivators of change and facilitate the development of plans and strategies to improve lifestyle habits using the results of this study.