Elsevier

Heart & Lung

Volume 39, Issue 2, March–April 2010, Pages 121-130
Heart & Lung

Issues in Cardiovascular Nursing
Qualitative examination of compliance in heart failure patients in The Netherlands

https://doi.org/10.1016/j.hrtlng.2009.07.008Get rights and content

Background

Noncompliance with pharmacological and nonpharmacological recommendations is a problem in many heart failure (HF) patients, leading to worse symptoms and readmission. Although knowledge is available regarding factors related to compliance with HF regimens, little is known about patients' perspectives. We investigated patients' reasons and motivations for compliance with HF regimens from their perspective, and we studied how patients manage these recommendations in daily life. The health belief model was used as a framework for this study.

Methods

A qualitative descriptive study was used, and 15 HF patients were interviewed about reasons for compliance, barriers to compliance, interventions that helped them comply with medications, sodium restriction, fluid restriction, and daily weighing.

Results

The most commonly reported reasons for compliance included fear of hospitalization and HF symptoms. Barriers to compliance were mainly related to the negative aspects of a regimen, e.g., taste of the food and thirst. Most patients tried to make their lifestyle changes part of the daily routine. Several problems and misunderstandings with the regimen were evident. Patients themselves offered many tips that helped them comply with the regimen.

Conclusions

To improve compliance in HF patients, patient-tailored interventions must be targeted at specific problems and patients' beliefs regarding the regimen, and aim at implementing the regimen into daily life. Healthcare providers need to emphasize the benefits of compliance, motivate patients to comply, and focus on individual barriers to compliance, knowledge deficits, and misunderstandings regarding the regimen. More specific advice about medications and diet is needed. Group interventions, including tips patients themselves provide, might also be useful in helping patients implement the HF regimen in their daily lives.

Section snippets

Methods

A qualitative descriptive study design was used to gain more insight into patients' own thoughts and motivations about compliance and interventions that help patients comply.

Clinical and demographic characteristics

Six female and 9 male patients with heart failure, between ages 42 and 87 years, and with a mean age of 70 years (SD ±13 years), were interviewed for this study. Seven patients lived with a partner, 2 patients lived with a partner and had children living at home, and 1 patient lived with his mother. We included patients with both diastolic and systolic dysfunction. Nine patients manifested a LVEF of <40% and a mean Left Ventriculair Ejection Fraction (LVEF) of 39% (±17%). Most patients (94%)

Discussion

Based on this study, important lessons can be learned about improving the daily care of heart failure patients from a patients' perspective. Firstly, the most frequently reported reasons for compliance included feeling better when complying, and fear of heart failure symptoms or readmission, which can, according to the HBM, be considered as the threat of the disease, leading to improvement of compliance.7 This confirms the findings of Wu et al,19 who reported that the desire to be healthy and

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    The Netherlands Heart Foundation is gratefully acknowledged for supporting this study (grant 2000Z003).

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