title: Context matters in heart failure self-care: a qualitative systematic review.
abstract: BACKGROUND
  The aim of this work was to identify the main contextual factors and processes that influence patients' self-care of heart failure (HF).
  
  
  RESULTS
  A systematic review was conducted with the use of qualitative meta-synthesis. Ten databases were searched up to March 19, 2012. Of the 1,421 papers identified by the systematic search, 45 studies were included in this meta-synthesis. To be included, studies had to contain a qualitative research component, data pertaining to self-care of HF from adults (≥18 y) and be published as full papers or theses since 1995. These studies involved: 1,398 patients (mean age 65.9 y), 180 caregivers, and 63 health professionals. Six main types of contextual factors were found to influence HF self-care in the studies: caregivers; social networks and social support; place; finances and financial capacity; work and occupation; and HF support groups and programs.
  
  
  CONCLUSIONS
  HF self-care is influenced by contextual elements that fall outside of traditional elements of a HF self-care program. Inclusion of these elements may help to address the current concerns about poor adherence to self-management programs.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
authors.affiliation: Institute for Applied Health Research, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.
authors.forename: Kay
authors.initials: K
authors.lastname: Currie
authors.affiliation: McMaster University, Heart Function Clinic, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harkness
authors.affiliation: University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada.
authors.forename: Melisa
authors.initials: M
authors.lastname: Spaling
authors.affiliation: University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada. Electronic address: alex.clark@ualberta.ca.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Clark
mesh_terms: D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D010349:Patient Compliance / Q000523:psychology; D012648:Self Care / Q000379:methods / Q000592:standards*; D012944:Social Support
keywords: Heart failure; context; meta-synthesis; self-care