Factors affecting self-care adherence in patients with heart failure in Saudi Arabia
- Publication Type:
- Thesis
- Issue Date:
- 2025
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The rising prevalence of heart failure (HF) globally is leading to increased morbidity, mortality, and financial burdens. The limited data on HF in Saudi Arabia challenges effective health strategy planning to improve outcomes and self-care among patients. This study aimed to determine self-care practices and identify factors affecting self-care adherence in Saudi Arabia. The research questions are:
β’ How do HF patients perceive and practice self-care?
β’ What is the level of self-care adherence among HF patients?
β’ What factors affect self-care adherence in HF patients?
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An integrative review identified factors affecting self-care adherence. An exploratory sequential mixed methods study recruited HF patients from outpatient clinics in Saudi Arabia. Fourteen participants completed semi-structured interviews, and 205 completed a survey. Directed qualitative content analysis described HF self-care. Self-care subscales were evaluated using the Arabic version of the heart failure self-care index (A-SCHFI). Explanatory factors were assessed using validated instruments and three multiple regression analyses modelled SCHFI subscales. Qualitative and quantitative data were triangulated and integrated.
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Factors affecting self-care adherence were categorised as personal, disease-related or environmental. Literature review findings revealed inconsistencies in factors between studies, suggesting varying cultural influences. The mean age of participants was 59.9 years, the majority were male (67.5%) and married (74.4%). Participants had a median duration of 5.0 years with HF, and most (87.9%) were classified at NYHA class I and II. Overall self-care scores were suboptimal with median self-care maintenance, self-care management and self-care confidence scores of 43.3, 45.0 and 55.6, respectively. Participants reported engaging in self-care practices such as adhering to their medication regimen, attending appointments, following a low-salt diet and participating in physical activities, although many acknowledged they struggled to maintain these practices. Standard practices such as checking for ankle swelling, requesting low-salt options when dining out, restricting fluid intake and avoiding sickness were not reported by participants. Nevertheless, participants highlighted other important practices, including seeking information, balancing work and rest, quitting smoking, establishing good sleep routines and managing stress. Predictive factors were identified for self-care maintenance, management and confidence scores.
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Greater attention is needed for HF patients least likely to engage in self-care, such as those who are physically inactive, employed, recently diagnosed, with lower NYHA severity, experiencing more hospital admissions, greater numbers of medications, and uncomfortable discussing their disease with healthcare providers. With a high percentage of variance remaining unexplained for each SCHFI subscale, more research is needed.
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