title: A qualitative meta-analysis of heart failure self-care practices among individuals with multiple comorbid conditions.
abstract: BACKGROUND
  Most heart failure (HF) patients have other comorbid conditions. HF self-care requires medication and diet adherence, daily weight monitoring, and a thoughtful response to symptoms when they occur. Self-care is complicated when other chronic conditions have additional self-care requirements. The purpose of this study is to explore how comorbidity influences HF self-care.
  
  
  METHODS
  Using qualitative descriptive meta-analysis techniques, transcripts from 3 mixed methods studies (n = 99) were reexamined to yield themes about perceptions about HF and self-care and to explore the influence on HF self-care. The Charlson Comorbidity Index identified comorbid conditions.
  
  
  RESULTS
  The sample was 74% Caucasian, 66% male (mean age of 59.6 years ± 15 years). Fifty-three percent of the sample was New York Heart Association Class III. All had at least 1 other chronic condition. Narrative accounts revealed that adherence to diet, symptom monitoring, and differentiating symptoms from multiple conditions were the most challenging self-care skills. Emerging themes included 1) attitudes drive self-care prioritization and 2) fragmented self-care instruction leads to poor self-care integration and self-care skill deficits.
  
  
  CONCLUSIONS
  Individuals with multiple chronic conditions are vulnerable to poor self-care. Research testing coaching interventions that integrate self-care requirements and focus on developing skill in self-care across multiple chronic conditions is needed.
authors.affiliation: New York University College of Nursing, New York, NY 10003, USA. vdickson@nyu.edu
authors.forename: Victoria Vaughan
authors.initials: VV
authors.lastname: Dickson
authors.forename: Harleah
authors.initials: H
authors.lastname: Buck
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000628:therapy; D012648:Self Care / Q000379:methods / Q000592:standards*; D020521:Stroke / Q000453:epidemiology / Q000628:therapy