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Clinical Observation
July 26, 1999

Factors Influencing Knowledge of and Adherence to Self-care Among Patients With Heart Failure

Author Affiliations

From the Oregon Heart Failure Project, Heart Failure Treatment Program (Drs Ni, Crispell, and Hershberger and Mss Nauman, Burgess, and Wise), and the Department of Public Health (Dr Ni), Oregon Health Sciences University, Portland, Ore.

Arch Intern Med. 1999;159(14):1613-1619. doi:10.1001/archinte.159.14.1613

Background  Patient education has been shown to be a key component in comprehensive heart failure management. Few data, however, are available regarding patients' knowledge of and adherence to self-care recommendations for the disease.

Objectives  To assess the knowledge level of and adherence to self-care among patients with heart failure and to determine associated factors.

Methods  We conducted a needs-assessment survey among new patients visiting a heart failure clinic from April 1997 through June 1998. Multiple linear regression analysis was used to assess the factors predictive of patients' knowledge level and adherence behaviors.

Results  Of the 113 patients surveyed, 77% were referred by cardiologists and 60% had New York Heart Association class III or IV status. Two thirds of the patients reported receiving information or advice about self-care from health care providers. When asked how much they knew about congestive heart failure, however, 37% said "a little or nothing," 49% said "some," and only 14% said "a lot." Approximately 40% of the patients did not recognize the importance of weighing themselves daily and 27% weighed themselves twice a month or less often. Although 80% of the patients knew they should limit their salt intake, only one third always avoided salty foods. Additionally, 25% of the patients did not appreciate the risk of alcohol use and 36% believed they should drink a lot of fluids. The multiple linear regression analysis indicated that a higher knowledge score was associated with being married, prior hospitalization, and having received both advice and information about self-care from physicians or nurses. A poor adherence behavior score was associated with being unmarried, lower perceived self-efficacy, a lack of knowledge about self-care, and no prior hospitalization.

Conclusions  We observed a gap between patients receiving and absorbing or retaining information on self-care for congestive heart failure supplied by health care providers. Self-care education needs to be directed to outpatients in addition to inpatients.