Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis

doi:10.1053/hl.1999.v28.a99538

Heart & Lung

Volume 28, Issue 5, September–October 1999, Pages 334-341

https://doi.org/10.1053/hl.1999.v28.a99538 Get rights and content

Abstract

Objective: The aim of this study was to identify factors influencing compliance with prescribed treatment in patients with chronic heart failure. Methods: A qualitative design with a critical incident technique was used. Incidents were collected through interviews with 25 patients with heart failure strategically selected from a primary health care clinic, a medical ward, and a specialist clinic. Results: Two hundred sixty critical incidents were identified in the interviews and 2 main areas emerged in the analysis: inward factors and outward factors. The inward factors described how compliance was influenced by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was influenced by social activities, social relationships, and health care professionals. Conclusions: By identifying the inward and outward factors influencing patients with chronic heart failure, health care professionals can assess whether intervention is needed to increase compliance. (Heart Lung® 1999;28:334-41)

Section snippets

Compliance

Compliance is defined by Haynes et al¹⁶ as “the extent to which a person’s behavior (in terms of taking medications, following diets, or executing other lifestyle changes) coincides with medical or health advice.” Understanding the mechanisms behind compliance and the factors that influence patients is of great importance. Demographic factors (age, sex, race, education, and socioeconomic status) do not significantly influence compliance.¹⁶ The patient/health care provider interaction has been

Design

A qualitative descriptive design was used for this study. The method used was critical incident technique (CIT), described by Flanagan²³ in 1954. CIT is a systematic, inductive method by which observations of human behavior in defined situations are collected. CIT provides concrete descriptions of incidents of importance to the activity under investigation.²⁴ A critical incident is a major event of great importance to the person involved.²³ The incidents can be collected through observations,

RESULTS

Two main areas emerged from the analysis of the incidents: inward factors influencing the patient and outward factors influencing the patient. The first main area, inward factors, described how compliance was affected by the personality of the patient, the disease, and the treatment. The second main area, outward factors, described how patient compliance was affected by social activities and the patient’s relationship to family, friends, and health care professionals. Table IV provides an

Personality affects patient compliance

This category described the patient’s beliefs, attitudes, and experiences in connection with chronic heart failure and its treatment. The patient adapted and learned how to cope with the situation: “I feel it myself when I have too much water in my body, and then I increase my diuretics to get rid of it.” To make it easier to follow the prescribed treatment the patient formed habits: “I always take my pills after breakfast; I get up, have coffee and a slice of bread, and after that I take the

Social activities affect patient compliance

This category described the manner in which diuretics and the weather affected the patient’s possibilities for participating in trips and social activities. The patient modified the intake of diuretics, “If you want to go out somewhere you can skip the diuretics.” “When I go to Stockholm by car, I don’t take any diuretics in the morning,” and was restricted by the weather: “I can’t go out when it’s windy, I can’t be out in the sun; I’ve had to make such changes in my lifestyle.”

Social relations affect patient compliance

This category

The patient is influenced by inward factors

The main area of inward factors described how compliance was affected by the patient’s personality, the disease, and the treatment. The first category contains two thirds of the incidents and deals with processes within the patient. The patients found it easier to follow the treatment when they had adapted to the disease and learned how to handle the medications and lifestyle changes. According to Mårtensson et al,²⁷ patients with heart failure chose different strategies when accepting and

CONCLUSION

The compliance of patients with heart failure with therapeutic regimens was influenced by both inward and outward factors. The inward factors described how compliance was affected by the personality of the patient, the disease, and the treatment. The outward factors described how compliance was affected by social activities and relationships to family, friends, and health care professionals. Inward factors that increased compliance were health improvement, adaptation, habits, respect for the

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To understand the process of help-seeking among heart failure patients from the perspectives of patients, caregivers and health professionals.
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58 studies (990 patients; 274 female, 527 male, 189 sex not described; 229 caregivers, 79 health professionals) were included. Heart failure help-seeking was embedded in daily experiences of heart failure but ongoing symptoms were confusing, ambiguous and disruptive; little support was available from professionals to interpret the presence and significance of fluctuations in symptoms for help-seeking. Other significant barriers to help-seeking were: avoidance-based coping, fear of hospitals and misplaced reluctance to be burdensome. Help-seeking was facilitated by good involvement and frank communication between patients, caregivers and health professionals and the presence of a sense of elevated personal risk.
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2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
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^*: Reprint requests: Anna Strömberg, Department of Cardiology, University Hospital, 581 85 Linköping, Sweden. E-mail: annst@ imv.liu.se

^**: 0147-9563/99/$8.00 + 0 2/1/99538

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Factors influencing patient compliance with therapeutic regimens in chronic heart failure: A critical incident technique analysis*,**

Abstract

Section snippets

Compliance

Design

RESULTS

Personality affects patient compliance

Social activities affect patient compliance

Social relations affect patient compliance

The patient is influenced by inward factors

CONCLUSION

Soc Sci Med

Soc Sci Med

Am J Med

The epidemiology of heart failure

Eur Heart J

Risk factors for heart failure in the general population: the study of men born in 1913

Eur Heart J

The epidemiology of heart failure: the Framingham study

J Am Coll Cardiol

Effects of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure

N Engl J Med

Effects of enalapril on mortality in severe congestive heart failure

N Engl J Med

Heart failure: evaluation and care of patients with left-ventricular systolic dysfunction

Management of heart failure II. Counseling, education and lifestyle modifications

JAMA

Self-care teaching, for congestive heart failure patients

J Gerontol Nurs

Trends in hospitalization for heart failure in Scotland 1980-1990

Eur Heart J

Clinical epidemiology of heart failure: public and private health burden

Eur Heart J

Noncompliance with congestive heart failure therapy in the elderly

Arch Intern Med

Precipitating factors leading to decompensation of heart failure, traits among urban blacks

Arch Intern Med