title: Congestive heart failure self-management among US veterans: The role of personal and professional advocates.
abstract: OBJECTIVE
  Understand patients' experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management.
  
  
  METHODS
  We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using thematic content analysis.
  
  
  RESULTS
  Participants acknowledged the importance of ongoing engagement in the plan of care for CHF. They attributed success in this effort to be greatly influenced by personal advocates. The advocates included both members of the healthcare team with whom they had a continuity relationship and friends or family members who assisted on a daily basis. Participants also identified psychological symptoms as a major barrier to carrying out self-care.
  
  
  CONCLUSIONS
  Patients identify relationships with health care workers, help from family and friends, and mental health problems as major influences on the ability to manage their CHF.
  
  
  CONCLUSIONS
  Efforts to optimize CHF self-management should attend to health system and psychosocial barriers to care.
authors.affiliation: Portland VA Medical Center Health Services Research and Development, VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Portland, USA. Electronic address: eleni.skaperdas@va.gov.
authors.forename: Eleni
authors.initials: E
authors.lastname: Skaperdas
authors.affiliation: Portland VA Medical Center Health Services Research and Development, VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Portland, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, USA.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Tuepker
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, USA; School of Social Work, Portland State University, Portland, USA; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Nicolaidis
authors.affiliation: Portland VA Medical Center Health Services Research and Development, VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Portland, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Robb
authors.affiliation: Portland VA Medical Center Health Services Research and Development, VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Portland, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, USA.
authors.forename: Devan
authors.initials: D
authors.lastname: Kansagara
authors.affiliation: Portland VA Medical Center Health Services Research and Development, VISN 20 PACT Demonstration Laboratory, Veterans Health Administration, Portland, USA; Patient Centered Outcomes Research Institute, Washington, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Hickam
mesh_terms: D000368:Aged; D019468:Disease Management; D005190:Family; D005260:Female; D006282:Health Personnel; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010344:Patient Advocacy; D011320:Primary Health Care; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Heart failure; Primary care redesign; Qualitative research; Self-management; US; Veterans