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Original Article

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

Jong Sun Ok1, Heejung Choi2
Korean Journal of Adult Nursing 2015;27(2):242-250.
Published online: April 30, 2015

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

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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: January 28, 2015   • Accepted: March 26, 2015

Copyright © 2015 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Heart failure; Self-care; Patient adherence
Table 1.
Demographic and Clinical Characteristic of the Participants (N=280)
Characteristics Categories n (%) or M±SD
Gender Male 182 (65.0)
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)
No 156 (55.7)
The number of comorbid disease   1.82±1.55
   
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
n (%) n (%) n (%) n (%) n (%) % %
1. I take my weight every day 38 56 104 51 31 70.7 29.3
(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
(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
(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
(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
(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
(18.2) (16.8) (15.0) (9.3) (40.7)    
12. I exercise regularly 28 68 67 48 69 58.2 41.7
(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
M±SD
Gender Female 98 30.43±7.19 7.93 .005  
Male 182 32.81±6.46
Age (year) 18~39a 26 32.50±6.21 5.59 .004 b ＜ c
40~64b 142 33.16±6.57
≥ 65c 112 30.35±6.96
Employment No 156 31.05±6.92 6.71 .010  
Yes 124 33.15±6.50
Marital status Marrieda 206 32.34±6.54 6.71 ＜.001 a, b, d ＜ c
Singleb 26 33.96±6.34
Bereavementc 35 27.54±7.74
Othersd 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 Ia 142 32.61±6.58 3.06 .048 a ＜ c
NYHA Fc IIb 111 31.87±6.94
NYHA Fc IIIc 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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    Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea
    Korean J Adult Nurs. 2015;27(2):242-250.   Published online April 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.2.242
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    DOI: https://doi.org/10.7475/kjan.2015.27.2.242
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    Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea
    Factors Affecting Adherence to Self-care Behaviors among Outpatients with Heart Failure in Korea

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

    Characteristics Categories n (%) or M±SD
    Gender Male 182 (65.0)
    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)
    No 156 (55.7)
    The number of comorbid disease   1.82±1.55
       
    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.

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

    Self-care behavior Not at all Not often Sometimes Often Always BA GA
    n (%) n (%) n (%) n (%) n (%) % %
    1. I take my weight every day 38 56 104 51 31 70.7 29.3
    (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
    (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
    (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
    (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
    (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
    (18.2) (16.8) (15.0) (9.3) (40.7)    
    12. I exercise regularly 28 68 67 48 69 58.2 41.7
    (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).

    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.

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

    Variables Categories n Self-care behavior t or F p Scheffé
    M±SD
    Gender Female 98 30.43±7.19 7.93 .005  
    Male 182 32.81±6.46
    Age (year) 18~39a 26 32.50±6.21 5.59 .004 b ＜ c
    40~64b 142 33.16±6.57
    ≥ 65c 112 30.35±6.96
    Employment No 156 31.05±6.92 6.71 .010  
    Yes 124 33.15±6.50
    Marital status Marrieda 206 32.34±6.54 6.71 ＜.001 a, b, d ＜ c
    Singleb 26 33.96±6.34
    Bereavementc 35 27.54±7.74
    Othersd 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 Ia 142 32.61±6.58 3.06 .048 a ＜ c
    NYHA Fc IIb 111 31.87±6.94
    NYHA Fc IIIc 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

    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.
    Table 1. Demographic and Clinical Characteristic of the Participants (N=280)

    NYHA Fc=New York Heart Association Functional Classification.

    Table 2. Adherence to Heart Failure Self-care Behaviors (N=280)

    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)

    PCA=percentage of correct answer.

    Table 4. Heart Failure Self-care Behavior according to the Participants' Characteristics (N=280)

    Table 5. Regression Analysis of Adherence to Self-care Behaviors (N=280)

    NYHA Fc=New York Heart Association Functional Classification;

    Currently married state.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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