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Motivation, Challenges and Self-Regulation in Heart Failure Self-Care: a Theory-Driven Qualitative Study

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Abstract

Background

Self-care behaviours are crucial in reducing chronic heart failure (HF) morbidity and mortality but performance remains poor worldwide. This study draws on Temporal Self-regulation Theory (TST) to explore participants’ motivations, challenges and personalised self-regulation strategies to enhance self-care.

Method

Seventeen HF patients were purposively sampled and recruited from outpatient and inpatient settings at a Singaporean tertiary hospital from December 2017 to March 2018. Unstructured face-to-face interviews were conducted. Data were analysed using thematic analysis with constant comparison.

Results

Five themes emerged. Self-care motivations were (1) consideration of family’s future and (2) consideration of own past, while demotivation was (3) fatalistic consideration of own future. Barriers of behaviour change were (4) difficulty adopting physical activity and (5) difficulty deviating from personal dietary habits and sociocultural dietary norms. Personalised strategies to overcome these challenges were described in the 12 subthemes that emerged. Themes were well-fitted into the TST—(1–3) corresponded to time perspective, (4–5) corresponds to behaviour prepotency and the subthemes corresponded to self-regulatory capacity. Motivation could be enhanced by stimulating considerations of one’s past regrets, family’s future well-being and real-life success stories to instil hope. Clinicians and case managers could enhance self-regulation by empowering patients with tactical and situational skills to develop personalised plans to improve lifestyle habits and strategies to resist temptations.

Conclusion

Future person-centred self-care interventions could be tailored according to the study findings. Better self-care could improve patient outcomes, reduce rehospitalisation and alleviate global healthcare burden. Findings could be generalised to healthy populations as primary prevention.

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Acknowledgements

We thank the doctors and nurses who have assisted us during the data collection for this study. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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HSJC, KLDS, XC, SYC: Made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data;

HSJC, XC, SYC: Involved in drafting the manuscript or revising it critically for important intellectual content;

HSJC, KLDS, XC, SYC: Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content;

HSJC, KLDS, XC, SYC: Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Han Shi Jocelyn Chew.

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Chew, H.S.J., Sim, K.L.D., Cao, X. et al. Motivation, Challenges and Self-Regulation in Heart Failure Self-Care: a Theory-Driven Qualitative Study. Int.J. Behav. Med. 26, 474–485 (2019). https://doi.org/10.1007/s12529-019-09798-z

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