Factors influencing knowledge of and adherence to self-care among patientswith heart failure

Background: Patient education has been shown to be a key component in compr ehensive heart failure management. Few data, however, are available regardi ng patients' knowledge of and adherence to self-care recommendations for th e disease. Objectives: To assess the knowledge level of and adherence to self-care amo ng 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 a nd 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 hear t failure, however, 37% said;ia little or nothing," 49% said "some," and on ly 14% said "a lot." Approximately 40% of the patients did not recognize th e 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% bel ieved they should drink a lot of fluids. The multiple linear regression ana lysis indicated that a higher knowledge score was associated with being mar ried, prior hospitalization, and having received both advice and informatio n about self-care from physicians or nurses. A poor adherence behavior scor e was associated with being unmarried, lower perceived self-efficacy, a lac k 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 outpati ents in addition to inpatients.