Self-Care Practices of Women With Heart Failure: A Mixed-Methods Study

Purpose: Self-care is paramount to the successful management of heart failure. Although recent trends in heart failure have shown a decline in hospitalizations and emergency room visits, observational unit admissions related to heart failure exacerbations continue to rise (Albert, 2016). While nearly half (47%) of the heart failure population is female, women are historically under-represented in heart failure research that guides best practice recommendations (Pressler, 2016). Therefore, the primary aim of this mixed methods study was to identify differences in women who demonstrate an adequate heart failure self-care maintenance (score >70) behaviors as compared to women who score inadequately (score < 69) as measured by the Self-Care of Heart Failure Index (SCHFI) version 6.2.

Methods: In this mixed methods study, a convergent design was used (Creswell, 2015). This research methodology is best for comparing and contrasting quantitative data with qualitative finding. Convergent designs are also best used to develop a deeper understanding of a phenomenon when there is equal value in both the quantitative and qualitative data. Following the methodology of this design, the study was conducted in one phase. In the quantitative strand of the study, a demographic questionnaire and the SCHFI were distributed to eligible patients being treated at a primary care clinic of an urban hospital. At the conclusion of collecting quantitative data, participants were invited to participate in the qualitative strand which consisted of a semi-structured, qualitative interview.

Results: Quantitative data revealed a significant, parabolic relationship between heart failure self-care maintenance and self-care confidence scores. Qualitative analysis suggested that assuming an active or passive role in heart failure self-care plays an important role in women’s heart failure self-care maintenance. Mixed methods analysis revealed that high heart failure self-care confidence levels may not reflect an adequate level of heart failure self-care maintenance behaviors.

Conclusion: In a population of women living with heart failure, self-care confidence is highest in those that score lowest on the SCFHI and those that score the highest. Those women scoring closer to the median of the distribution of scores seemed to have the lowest self-care confidence scores.