Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea

Jong Sun Ok; Heejung Choi

doi:10.7469/kjan.2015.27.2.242

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Ok and Choi: Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea

Original Article

Korean J Adult Nurs 2015;27(2):242-250.

Published online: NaN April 2015

DOI: https://doi.org/10.7469/kjan.2015.27.2.242

Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea

Jong Sun Ok¹, Heejung Choi²

^¹Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong

^²Department of Nursing, Konkuk University, Chungju, Korea

Corresponding author: Choi, Heejung Department of Nursing, Konkuk University, 268 Chungwon-daero, Chungju 380-701, Korea. Tel: +82-43-840-3954, Fax: +82-43-840-3929, E-mail: hjchoi98@kku.ac.kr

Received 28 January 201525 March 2015 Accepted 26 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate heart failure knowledge and adherence to selfcare behaviors, andto identify factors affecting adherence to self-care behaviors among Korean patients with heart failure.

Methods

Correlational research using the European Heart Failure Self-care Behavior Scale, the Duke Activity Status Index, the Dutch Heart Failure Knowledge Scale, the New York Heart Association Functional Classification, and the Medical Outcomes Study Social Support Survey was conducted. A total of 280 outpatients with heart failure responded to the five questionnaires.

Results

The mean scores for self-care adherence and heart failure knowledge were 31.98 ± 6.81 and 8.78 ± 2.53, respectively, indicating lower adherence and knowledge than those previously reported. Subjects with lower functional status, more social supports, and greater knowledge of heart failure are more likely to adhere to prescribed regimens.

Conclusion

Nurses should focus on patient education and support to improve their adherence to self-care behaviors.

Keywords: Heart failure, Self-care, Patient adherence

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Table 1.

Demographic and Clinical Characteristic of the Participants (N=280)

Characteristics	Categories	n (%) or M±SD
Gender	Male	182 (65.0)
Gender	Female	98 (35.0)
Age		59.5±13.83
	20's	11 (3.9)
	30's	15 (5.4)
	40's	31 (11.1)
	50's	76 (27.1)
	60's	73 (26.1)
	70's	61 (21.8)
	Over 80	13 (4.6)
Marital status	Married	206 (73.6)
	Single	26 (9.3)
	Bereavement	35 (12.5)
	Divorce	10 (3.6)
	Other	3 (1.1)
Education	Illiterate	21 (7.5)
	Elementary school	47 (16.8)
	Middle school	40 (14.3)
	High school	86 (30.7)
	≥ University	86 (30.7)
Occupation	Yes	124 (44.3)
Occupation	No	156 (55.7)
The number of comorbid disease		1.82±1.55
The number of comorbid disease
The type of comorbid disease	Cardiovascular	166 (59.3)
	Diabetes mellitus	56 (20.0)
	Cancer	19 (6.8)
	Others	121 (43.2)
Symptom severity	NYHA Fc I	142 (50.7)
	NYHA Fc II	111 (39.6)
	NYHA Fc III	27 (9.6)

NYHA Fc=New York Heart Association Functional Classification.

Table 2.

Adherence to Heart Failure Self-care Behaviors (N=280)

Self-care behavior	Not at all	Not often	Sometimes	Often	Always	BA	GA
Self-care behavior	n (%)	n (%)	n (%)	n (%)	n (%)	%	%
1. I take my weight every day	38	56	104	51	31	70.7	29.3
1. I take my weight every day	(13.6)	(20.0)	(37.1)	(18.2)	(11.1)
2. If I am out of breath, I will take a rest	9	18	74	67	112	36.0	63.9
2. If I am out of breath, I will take a rest	(3.2)	(6.4)	(26.4)	(23.9)	(40.0)
3. If I feel respiratory distress is worse, I will contact with a doctor or a nurse	35	39	74	52	80	52.8	47.2
	(12.5)	(13.9)	(26.4)	(18.6)	(28.6)
4. If my feet or legs become swollen more than usual, I will contact with a doctor or a nurse	44	70	63	40	63	63.2	36.8
	(15.7)	(25.0)	(22.5)	(14.3)	(22.5)
5. If my body weight is increased by over 2 kg in a week, I will contact with a doctor or a nurse	62	100	58	24	36	78.5	21.5
	(22.1)	(35.7)	(20.7)	(8.6)	(12.9)
6. I limit my fluids (soup, coffee, water, and beverage) intake	26	44	69	72	69	49.6	50.3
	(9.3)	(15.7)	(24.6)	(25.7)	(24.6)
7. I take a rest during the day	2	35	104	43	96	50.3	49.7
7. I take a rest during the day	(0.7)	(12.5)	(37.1)	(15.4)	(34.3)
8. If I feel more fatigue, I will contact with a doctor or a nurse	58	106	62	17	37	80.7	19.3
	(20.7)	(37.9)	(22.1)	(6.1)	(13.2)
9. I take a low-salt diet	38	47	72	75	48	56.1	43.9
9. I take a low-salt diet	(13.6)	(16.8)	(25.7)	(26.8)	(17.1)
10. I take the prescribed medicines well	0	3	4	31	242	2.5	97.5
10. I take the prescribed medicines well	(0)	(1.1)	(1.4)	(11.1)	(86.4)
11. I receive a flu shot (inoculation) every year	51	47	42	26	114	50.0	50.0
11. I receive a flu shot (inoculation) every year	(18.2)	(16.8)	(15.0)	(9.3)	(40.7)
12. I exercise regularly	28	68	67	48	69	58.2	41.7
12. I exercise regularly	(10.0)	(24.3)	(23.9)	(17.1)	(24.6)
The total score M±SD	31.98±6.81

BA=bad adherence: participant's response of (not at all ＋ not often ＋ sometimes); GA=good adherence: participant's response of (often ＋ always).

Table 3.

Heart Failure Knowledge (N=280)

Items	PCA n (%)
1. How often does a patient with severe heart failure need to take his or her own weight?	97 (34.6)
2. Why is it important for a heart failure patient to take his or her own weight regularly?	126 (45.0)
3. How much water intake is allowed for a day?	139 (49.6)
4. Which of the following statements is correct regarding medicine intake?	252 (90.0)
5. What action should the patient take if he or she is out of breath or the legs are swollen?	221 (78.9)
6. Which of the followings can increase the symptoms of heart failure?	84 (30.3)
7. What dose 'heart failure' mean?	194 (69.3)
8. Why are the legs swollen when there is heart failure?	100 (35.7)
9.What is the function of the heart?	156 (55.7)
10. Why should a heart failure patient follow low-salt diet?	104 (37.1)
11. What is the main cause of heart failure?	198 (70.7)
12. Which of the following statements is correct regarding the physical exercise for a heart failure patient at home?	249 (88.9)
13. Why should a heart failure patient take diuretics?	162 (57.9)
14. Which of the following statements is correct regarding the relationship between heart failure and weight increase?	164 (58.6)
15. What is the best when feeling thirsty?	212 (75.7)

PCA=percentage of correct answer.

Table 4.

Heart Failure Self-care Behavior according to the Participants' Characteristics (N=280)

Variables	Categories	n	Self-care behavior	t or F	p	Scheffé
Variables	Categories	n	M±SD	t or F	p	Scheffé
Gender	Female	98	30.43±7.19	7.93	.005
Gender	Male	182	32.81±6.46	7.93	.005
Age (year)	18~39^a	26	32.50±6.21	5.59	.004	b ＜ c
	40~64^b	142	33.16±6.57
	≥ 65^c	112	30.35±6.96
Employment	No	156	31.05±6.92	6.71	.010
Employment	Yes	124	33.15±6.50	6.71	.010
Marital status	Married^a	206	32.34±6.54	6.71	＜.001	a, b, d ＜ c
	Single^b	26	33.96±6.34
	Bereavement^c	35	27.54±7.74
	Others^d	13	34.15±4.57
Education	Illiterate	21	29.19±8.37	1.81	.127
	Elementary school	47	31.00±7.63
	Middle school	40	32.80±6.72
	High school	86	31.77±5.71
	≥ University	86	33.02±6.85
Symptom severity	NYHA Fc I^a	142	32.61±6.58	3.06	.048	a ＜ c
	NYHA Fc II^b	111	31.87±6.94
	NYHA Fc III^c	27	29.11±6.95
The number of comorbid disease				1.56	.147
The type of comorbid disease	Cardiovascular	105	32.05±6.77	1.63	.182
	Diabetes mellitus	88	31.35±7.09
	Cancer	27	30.48±6.27
	Others	60	33.45±6.57

Table 5.

Regression Analysis of Adherence to Self-care Behaviors (N=280)

Variables	B	SE	β	t	p	VIF
Social support	-0.08	0.02	-.23	-3.77	＜ .001	1.23
Heart failure knowledge	-0.46	0.17	-.17	-2.77	.006	1.22
Marital status (Married^†)	2.14	0.92	.14	2.34	.020	1.13
Age (year)	-0.08	0.04	-.16	-2.16	.031	1.71
Functional status	0.08	0.04	.19	2.10	.036	2.59
Gender (Male)	0.75	0.90	.05	0.82	.409	1.28
Occupation (Employed)	0.37	0.91	.03	0.40	.686	1.41
NYHA Fc I	1.21	1.58	.09	0.76	.444	4.31
NYHA Fc II	1.61	1.45	.12	1.10	.269	3.48

NYHA Fc=New York Heart Association Functional Classification;

^† Currently married state.

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