title: Qualitative examination of compliance in heart failure patients in The Netherlands.
abstract: 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.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box30,001, 9700 RB Groningen, The Netherlands. m.h.l.van.der.wal@thorax.umcg.nl
authors.forename: Martje H L
authors.initials: MH
authors.lastname: van der Wal
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
mesh_terms: D000368:Aged; D003376:Counseling; D005239:Fear; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D009042:Motivation; D009426:Netherlands / Q000453:epidemiology; D010349:Patient Compliance; D010353:Patient Education as Topic; D036301:Qualitative Research